Baseline demographic and comorbidity burden of patients with supranormal glomerular filtration rate: a distinct phenotype?

Abstract

Background Introduction: A supranormal glomerular filtration rate (GFR) in heart failure has been proposed as a marker of altered cardiorenal physiology rather than isolated renal hyperfunction. However, the clinical significance of supranormal GFR (>90ml/dk/1.73m2) and its association with heart failure phenotypes and disease severity remain incompletely characterized. Purpose To determine whether heart failure patients with supranormal GFR exhibit a distinct clinical, phenotypic, and comorbidity profile compared with those with normal GFR. Methods This cross-sectional analysis included 947 patients enrolled in a multicenter heart failure registry. Patients were classified as having supranormal GFR (n = 231, 24.4%) or normal /reduced GFR (n = 716, 75.6%). Demographic characteristics, heart failure phenotypes, comorbidities, hospitalization history, structural and rhythm abnormalities, procedural history, medication use, and vaccination status were compared. Subgroup analyses were performed across left ventricular ejection fraction (LVEF) categories. Results Heart failure phenotype distribution differed significantly between groups (p = 0.004, Table 1), with supranormal GFR more frequently observed in patients with reduced LVEF. Across the cohort, supranormal GFR was associated with lower rates of prior heart failure–related hospitalization, emergency department admissions, and oral diuretic dose escalation (all p < 0.001, Table 1). Patients with supranormal GFR demonstrated a substantially lower prevalence of hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, anemia, and iron deficiency (all p < 0.001). Supranormal GFR was consistently associated with lower NYHA functional class across all LVEF groups (p ≤ 0.001, Table 2). Prior cardiac surgery, was less frequent, and vaccination rate was higher in the supranormal GFR group (all p <0.05). Conclusion Heart failure patients with supranormal GFR exhibit a distinct clinical phenotype characterized by lower cardiometabolic burden, less symptomatic disease, and reduced markers of heart failure severity. These findings support supranormal GFR as a meaningful cardiorenal phenotype and highlight the need for longitudinal studies to clarify its prognostic implications and relevance for personalized management strategies. Baseline assessment of supranormal GFR may help identify heart failure patients with a distinct clinical profile and potentially different care needs. For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.