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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension
Xin Wang1, Guang Hao2, Lu Chen1
1Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Heart failure (HF) and left ventricular (LV) dysfunction are common in older adults with chronic kidney disease (CKD). Smoking is a significant risk factor for HF and LV diastolic dysfunction in this population.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Heart failure (HF) is a major cause of hospitalization and mortality in elderly patients with chronic kidney disease (CKD).
- Epidemiological data on HF and left ventricular (LV) dysfunction in this demographic is limited.
- Understanding the prevalence and risk factors is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence of LV dysfunction and HF in older adults with CKD.
- To identify risk factors associated with HF in this patient group.
Main Methods:
- Cross-sectional analysis of the China Hypertension Survey (2012-2015).
- Inclusion of 5,808 participants aged ≥ 65 years.
- Assessment of HF history, cardiovascular diseases, and LV dysfunction via echocardiography.
- Definition of CKD based on eGFR and urinary albumin-to-creatinine ratio (ACR).
Main Results:
- The weighted prevalence of HF was 4.8% among elderly CKD patients.
- Prevalence of HF was 5.0% with eGFR < 60 mL/min/1.73 m² and 5.9% with ACR ≥ 30 mg/g.
- LV systolic dysfunction prevalence was 3.1%, and moderate/severe diastolic dysfunction was 8.9%.
- Smoking was significantly associated with HF risk.
- Age, smoking, and rural residence were linked to LV diastolic dysfunction risk.
Conclusions:
- A high prevalence of HF and LV dysfunction exists in older CKD patients.
- Targeted strategies are necessary to manage HF and LV dysfunction in this vulnerable population.
Background:
Heart failure (HF) is a leading cause of hospitalization and mortality for older chronic kidney disease (CKD) patients. However, the epidemiological data is scarce. We aimed to determine the prevalence of left ventricular (LV) dysfunction and HF, and to explore the risk factors for HF among those patients.
Methods:
This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015. A total of 5, 808 participants aged ≥ 65 years were included in the analysis. Self-reported history of HF and any other cardiovascular diseases was acquired. 2-D and Doppler echocardiography were used to assess LV dysfunction. CKD was defined as either estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio (ACR) ≥ 30 mg/g.
Results:
Among CKD patients aged ≥ 65 years, the weighted prevalence of HF, heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) was 4.8%, 2.5%, 0.8%, and 1.7%, respectively. The weighted prevalence of HF was 5.0% in patients with eGFR < 60 mL/min per 1.73 m2, and was 5.9% in patients with ACR ≥ 30 mg/g. The prevalence of LV systolic dysfunction was 3.1%, and while it was 8.9% for moderate/severe diastolic dysfunction. Multivariate analysis showed that smoking was significantly associated with the risk of HF. Furthermore, age, smoking, and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.
Conclusions:
The prevalence of HF and LV dysfunction was high in older patients with CKD, suggesting that particular strategies will be required.
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