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Heart rate, age and the risk of progression to kidney failure in patients with CKD
Carmine Zoccali1, Daniela Leonardis, Giuseppe Enia
1Nephrology, Dialysis and Transplantation Unit, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
Insights
Heart rate predicts kidney failure in older adults with chronic kidney disease (CKD). Higher heart rates increase the risk of kidney events, particularly in elderly CKD patients, suggesting sympathetic activity impacts renal outcomes.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Heart rate (HR) is a cardiovascular risk factor and sympathetic activity marker.
- Chronic kidney disease (CKD) affects millions globally, with progression to kidney failure being a major concern.
Purpose of the Study:
- To investigate the predictive value of heart rate for kidney failure progression in CKD patients.
- To determine if age modifies the relationship between heart rate and kidney failure risk.
Main Methods:
- A cohort of 759 patients with stage 2-5 CKD was followed for 29 ± 11 months.
- Statistical analyses, including multiple Cox regression, were used to assess the association between HR and renal events.
- Effect modification by age was specifically examined.
Main Results:
- A 5 beats/min increase in HR was associated with a 16% increased risk of renal events (HR = 1.16, P = .004) in patients older than 68 years.
- No significant excess risk was observed in younger age groups.
- A significant interaction between age and the risk of renal events associated with proteinuria was found (P<.001).
Conclusions:
- Heart rate is an independent, age-dependent modifier of kidney failure progression in CKD patients.
- High sympathetic activity may be a significant risk factor for adverse renal outcomes in elderly CKD patients.
- These findings highlight the importance of considering age in assessing cardiovascular risk in CKD.
Background And Methods:
Since heart rate (HR) is a cardiovascular risk factor and a marker of sympathetic activity, we tested the predictive value of HR for progression to kidney failure in a well characterized cohort of 759 patients with stage 2-5 CKD followed up for 29 ± 11 months.
Results:
Overall, a total of 244 patients had renal events. In an unadjusted analysis by age tertiles the predictive value of HR for renal events was apparent only in patients in the third age tertile (older than 68 years) but not in those in the first two tertiles indicating effect modification by age of the HR--progression to kidney failure relationship. In a multiple Cox regression model adjusting for potential confounders, a 5 beats/min increase in HR entailed a 16% risk excess (Hazard Ratio = 1.16, P = .004) for renal events in patients in the third age tertile but no excess risk for the same events in patients in the first two tertiles. A statistically significant interaction (P<.001) was also found between age and the risk for renal events associated with proteinuria.
Conclusions:
Heart rate is an independent age-dependent effect modifier for progression to kidney failure in CKD patients. This observation generates the hypothesis that high sympathetic activity is a relevant risk factor for adverse renal outcomes in elderly patients with CKD.
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