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ESRD and death after heart failure in CKD

Maneesh Sud1, Navdeep Tangri2, Melania Pintilie3

  • 1Department of Medicine.

Journal of the American Society of Nephrology : JASN
|September 6, 2014
PubMed

Insights

Recurrent heart failure hospitalizations significantly increase the risk of end-stage renal disease (ESRD) and death in patients with chronic kidney disease (CKD). Each additional hospitalization further elevates these risks, highlighting a critical link between heart and kidney health.

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.

Keywords:
CKDESRDclinical epidemiologycongestive heart failuremortality risk

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