Related Experiment Videos

Association of chronic kidney disease with outcomes in chronic heart failure: a propensity-matched study

Ruth C Campbell1, Xuemei Sui, Gerasimos Filippatos

  • 11University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|August 20, 2008
PubMed

Insights

Chronic kidney disease (CKD) significantly increases hospitalization and mortality risk in heart failure (HF) patients. This risk escalates with declining kidney function, underscoring the importance of managing CKD in HF care.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Research

Background:

  • Chronic kidney disease (CKD) is a known risk factor for mortality in heart failure (HF) patients.
  • The impact of CKD on hospitalization rates in HF patients remains less understood.

Purpose of the Study:

  • To investigate the association between CKD and hospitalization and mortality in ambulatory patients with chronic HF.
  • To quantify the risk of hospitalization and death based on varying degrees of kidney function.

Main Methods:

  • Analysis of 7788 patients from the Digitalis Investigation Group trial, with 3527 identified as having CKD (eGFR <60 ml/min/1.73 m² BSA).
  • Propensity score matching was used to create comparable groups of patients with and without CKD (2399 pairs).
  • Matched Cox regression models analyzed the association of CKD with all-cause and cause-specific hospitalization and death.

Main Results:

  • CKD was associated with a 18% increased risk of all-cause hospitalization (HR 1.18, P < 0.0001) and a 28% increased risk of HF hospitalization (HR 1.28, P < 0.0001).
  • Patients with eGFR <45 ml/min/1.73 m² BSA had a 58% higher risk of hospitalization (HR 1.58) and a 70% higher risk of death (HR 1.70) compared to those with eGFR ≥60 ml/min/1.73 m² BSA.
  • CKD also increased the risk of cardiovascular death (HR 1.24) and death from progressive HF (HR 1.42).

Conclusions:

  • CKD is significantly associated with increased hospitalization and mortality in patients with chronic heart failure.
  • The risk of adverse outcomes, including death and hospitalization, increases progressively as kidney function declines in HF patients.
Abstract

Related Concept Videos

Chronic Kidney Disease IV: Nursing Management01:18

Chronic Kidney Disease IV: Nursing Management

Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of fluid...
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
Chronic Kidney Disease II: Clinical Manifestations01:24

Chronic Kidney Disease II: Clinical Manifestations

Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...