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Characteristics of Patients with Heart Failure and Advanced Chronic Kidney Disease (Stages 4-5) Not Undergoing Renal
Sandra Valdivielso Moré1,2,3, Miren Vicente Elcano1, Anna García Alonso1
1Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain.
Insights
Heart failure (HF) is common in advanced chronic kidney disease (CKD). Previous HF indicates a higher risk of hospitalization or need for renal replacement therapy (RRT) in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Advanced chronic kidney disease (CKD) frequently coexists with heart failure (HF), yet this association remains understudied.
- The prevalence and prognostic significance of HF in advanced CKD patients are not well understood.
Purpose of the Study:
- To investigate the prevalence and prognostic impact of heart failure (HF) in patients with advanced chronic kidney disease (CKD).
- To identify high-risk subgroups within the advanced CKD population based on HF history.
Main Methods:
- Retrospective study of 217 advanced CKD (stages 4-5) patients not on renal replacement therapy (RRT).
- Two-year follow-up period.
- Primary outcome: all-cause death or need for RRT.
Main Results:
- Forty percent of patients had a history of HF.
- Previous HF was associated with a higher risk of all-cause hospitalization or RRT (HR 1.62; 95% CI 1.04-2.52; p=0.034).
- No significant difference in the need for RRT was observed between groups; however, all-cause death was numerically higher in patients with prior HF.
Conclusions:
- Advanced CKD patients exhibit a high prevalence of HF.
- A history of HF identifies a high-risk population with a worse prognosis requiring close monitoring.
Background:
Despite the frequent coexistence of heart failure (HF) in patients with advanced chronic kidney disease (CKD), it has been understudied, and little is known about its prevalence and prognostic relevance.
Methods:
A retrospective study of 217 patients with advanced CKD (stages 4 and 5) who did not undergo renal replacement therapy (RRT). The patients were followed up for two years. The primary outcome was all-cause death or the need for RRT.
Results:
Forty percent of patients had a history of HF. The mean age was 78.2 ± 8.8 years and the mean eGFR was 18.4 ± 5.5 mL/min/1.73 m2. The presence of previous HF identified a subgroup of high-risk patients with a high prevalence of cardiovascular comorbidities and was significantly associated with the composite endpoint of all-cause hospitalization or need for RRT (66.7% vs. 53.1%, HR 95% CI 1.62 (1.04-2.52), p = 0.034). No differences were found in the need for RRT (27.6% vs. 32.2%, p = 0.46). Nineteen patients without HF at baseline developed HF during the follow-up and all-cause death was numerically higher (36.8 vs. 19.8%, p = 0.1).
Conclusions:
Patients with advanced CKD have a high prevalence of HF. The presence of previous HF identified a high-risk population with a worse prognosis that required close follow-up.
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