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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Prognostic Impact of Chronic Kidney Disease in Patients with Heart Failure
Nektar Nikki Hakopian1, Derenik Gharibian1, Marlene M Nashed1
1Pharmacy Residency Program, Los Angeles Medical Center, CA.
Insights
Patients with advanced chronic kidney disease (CKD) and heart failure (HF) face significantly higher hospitalization, readmission, and mortality risks. Early-stage CKD in HF patients shows better outcomes, highlighting the impact of CKD progression on HF prognosis.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Heart failure (HF) and chronic kidney disease (CKD) frequently coexist due to shared risk factors.
- The co-occurrence of cardiac and renal dysfunction exacerbates patient prognosis.
Purpose of the Study:
- To investigate the association between the progression of CKD and hospitalization, 30-day readmission, and mortality rates in patients diagnosed with HF.
Main Methods:
- A retrospective analysis of 27,366 patients with comorbid HF and CKD was conducted between 2012 and 2016.
- Patients were stratified into early-stage CKD (stages 1-3) and late-stage CKD (stages 4-5) based on estimated glomerular filtration rate.
Main Results:
- Patients with late-stage CKD and HF exhibited higher rates of all-cause hospitalization (RR=1.56), HF-related hospitalization (RR=1.25), and 30-day readmissions (RR=1.46) compared to early-stage CKD patients.
- Higher hospitalization rates persisted in subsequent years for the late-stage CKD cohort.
- The late-stage CKD group faced a significantly higher risk of 5-year mortality (HR=1.40).
Conclusions:
- Advanced CKD (stages 4-5) significantly worsens prognosis for patients with HF.
- Late-stage CKD is a major factor contributing to increased hospitalization, readmission, and mortality in HF patients.
Introduction:
Heart failure (HF) and chronic kidney disease (CKD) share many risk factors, and cardiac and renal dysfunction often coexist. The close association between HF and CKD worsens patient prognosis.
Objective:
To examine the association between progressing CKD with rates of hospitalization, 30-day readmission, and mortality in patients with HF.
Methods:
A retrospective analysis was conducted from January 1, 2012, to December 31, 2016, in the Kaiser Permanente Southern California Region. All patients age 18 years or older with a diagnosis of comorbid CKD and HF were included. Patients were excluded if they were noncontinuous members of Kaiser Permanente. Those included in the study were stratified into 2 cohorts: Early-stage CKD (stages 1, 2, and 3) and late-stage CKD (stages 4 and 5) on the basis of their estimated glomerular filtration rate in accordance with the National Kidney Foundation.
Results:
A total of 27,366 patients were identified with comorbid HF and CKD. At the first year of follow-up, patients with HF and late-stage CKD had higher all-cause hospitalization (rate ratio [RR] = 1.56, 95% confidence interval [CI] = 1.48-1.65, p < 0.001), HF-related hospitalization (RR = 1.25, 95% CI = 1.20-1.41, p = 0.001), and 30-day readmission rates (RR = 1.46, 95% CI = 1.31-1.63, p < 0.001) compared with patients with HF and early-stage CKD. In subsequent follow-up years, patients continued to have higher all-cause and HF-related hospitalization rates in late-stage CKD. The late-stage CKD cohort had a significantly higher risk of 5-year mortality (hazard ratio = 1.40, 95% CI = 1.35-1.45, p < 0.001).
Conclusion:
Stage 4 and 5 CKD is a significant contributor to poor prognosis in patients with HF, leading to significantly higher rates of hospitalization, 30-day readmission, and mortality.
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