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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Heart Failure-Type Symptom Score Trajectories in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC)
Carl P Walther1, Julia S Benoit2, Nisha Bansal3
1Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas.
Insights
Heart failure symptoms in chronic kidney disease patients vary significantly. Five distinct symptom trajectories were identified, highlighting diverse patient experiences and informing personalized care strategies for chronic kidney disease (CKD) and heart failure (HF).
Area of Science:
- Nephrology
- Cardiology
- Quality of Life Research
Background:
- Quality of life in chronic kidney disease (CKD) is often impaired by symptoms that overlap with heart failure (HF).
- Understanding the patterns and progression of HF-type symptoms in CKD patients is crucial for effective management.
Purpose of the Study:
- To identify and characterize distinct trajectories of heart failure-type symptoms in individuals with chronic kidney disease.
- To explore the baseline characteristics associated with different symptom trajectories in this population.
Main Methods:
- A prospective cohort study of 3,044 participants from the Chronic Renal Insufficiency Cohort (CRIC) study without a prior HF diagnosis.
- Latent class mixed models were used to analyze the trajectory of a heart failure-type symptom score (modified Kansas City Cardiomyopathy Questionnaire) over 5.5 years.
- Multinomial logistic regression examined relationships between baseline predictors (sociodemographics, medical history, lab values, etc.) and trajectory group membership.
Main Results:
- Five distinct trajectories of heart failure-type symptoms were identified.
- The majority of participants (41.7%) had stable, minimal symptoms. Other groups showed stable mild symptoms (35.6%), stable clinically significant symptoms (15.6%), worsening symptoms (4.9%), or improving symptoms (2.2%).
- Baseline characteristics like sex, diabetes, obesity, kidney function, proteinuria, and cardiovascular disease prevalence differed across symptom trajectories.
Conclusions:
- Distinct trajectories of heart failure-type symptom burden exist in individuals with chronic kidney disease.
- These trajectories are associated with varying baseline characteristics, underscoring the heterogeneity of symptom experience in CKD patients.
- The findings emphasize the need for personalized approaches to managing symptoms in the CKD population.
Rationale & Objective:
Quality of life in chronic kidney disease (CKD) is impaired by a large burden of symptoms including some that overlap with the symptoms of heart failure (HF). We studied a group of individuals with CKD to understand the patterns and trajectories of HF-type symptoms in this setting.
Study Design:
Prospective cohort study.
Setting & Participants:
3,044 participants in the Chronic Renal Insufficiency Cohort (CRIC) without prior diagnosis of HF.
Predictors:
Sociodemographics, medical history, medications, vital signs, laboratory values, echocardiographic and electrocardiographic parameters.
Outcome:
Trajectory over 5.5 years of a HF-type symptom score (modified Kansas City Cardiomyopathy Questionnaire [KCCQ] Overall Summary Score with a range of 0-100 where<75 reflects clinically significant symptoms).
Analytical Approach:
Latent class mixed models were used to model trajectories. Multinomial logistic regression was used to model relationships of predictors with trajectory group membership.
Results:
Five trajectories of KCCQ score were identified in the cohort of 3,044 adults, 45% of whom were female, and whose median age was 61 years. Group 1 (41.7%) had a stable high score (minimal symptoms, average score of 96); groups 2 (35.6%) and 3 (15.6%) had stable but lower scores (mild symptoms [average of 81] and clinically significant symptoms [average of 52], respectively). Group 4 (4.9%) had a substantial worsening in symptoms over time (mean 31-point decline), and group 5 (2.2%) had a substantial improvement (mean 33-point increase) in KCCQ score. A majority of group 1 was male, without diabetes or obesity, and this group had higher baseline kidney function. A majority of groups 2 and 3 had diabetes and obesity. A majority of group 4 was male and had substantial proteinuria. Group 5 had the highest proportion of baseline cardiovascular disease (CVD).
Limitations:
No validation cohort available, CKD management changes in recent years may alter trajectories, and latent class models depend on the missing at random assumption.
Conclusions:
Distinct HF-type symptom burden trajectories were identified in the setting of CKD, corresponding to different baseline characteristics. These results highlight the diversity of HF-type symptom experiences in individuals with CKD.
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