ESRD and death after heart failure in CKD

Area of Science:

• Nephrology
• Cardiology
• Public Health

Background:

• Chronic kidney disease (CKD) is a known risk factor for heart failure.
• The impact of recurrent heart failure hospitalizations on the risk of end-stage renal disease (ESRD) and mortality in CKD patients remains understudied.

Purpose of the Study:

• To investigate how interim heart failure hospitalizations affect the subsequent risk of ESRD or death before ESRD in patients with CKD.
• To quantify the association between the number of heart failure hospitalizations and adverse renal and survival outcomes.

Main Methods:

• Retrospective cohort study of 2887 CKD patients (GFR 15-60 ml/min/1.73 m²) referred to a nephrology clinic.
• Ascertainment of heart failure hospitalizations, ESRD, and death before ESRD using administrative data.
• Survival analysis to determine hazard ratios for ESRD and death before ESRD based on the number of heart failure hospitalizations.

Main Results:

• Over a median follow-up of 3.01 years, 12% of patients had heart failure hospitalizations, 8% developed ESRD, and 17% died before ESRD.
• Compared to no hospitalizations, one, two, or three+ heart failure hospitalizations increased the adjusted hazard ratio for ESRD to 4.89, 10.27, and 14.16, respectively.
• Similarly, adjusted hazard ratios for death before ESRD increased from 3.30 (one hospitalization) to 6.87 (three+ hospitalizations).

Conclusions:

• Recurrent interim heart failure hospitalizations are associated with a stepwise increase in the risk of ESRD in CKD patients.
• The number of heart failure hospitalizations also correlates with an elevated risk of death before ESRD among individuals with CKD.
• These findings underscore the critical interplay between heart and kidney health and the prognostic significance of heart failure hospitalizations in CKD management.