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Cardiogenic shock and chronic kidney disease: Dangerous liaisons
Miloud Cherbi1, Eric Bonnefoy2, Etienne Puymirat3
1Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France.
Insights
Patients with chronic kidney disease (CKD) experiencing cardiogenic shock face significantly higher mortality rates. Renal replacement therapy (RRT) further increases death risk, underscoring the need for integrated care.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Chronic kidney disease (CKD) is a major global health issue, strongly linked to cardiovascular diseases, often resulting in cardiorenal syndrome.
- Cardiogenic shock (CS) in CKD patients is understudied, despite its critical implications.
Purpose of the Study:
- To investigate the outcomes of cardiogenic shock in patients with and without chronic kidney disease.
- To identify risk factors and treatment patterns associated with CS in CKD patients.
Main Methods:
- The study utilized data from the prospective FRENSHOCK registry (NCT02703038), involving 772 patients across 49 centers.
- One-year outcomes were analyzed based on the presence of CKD at admission, with adjustments for independent predictive factors.
Main Results:
- 21.3% of CS patients had CKD; they were older and had more comorbidities.
- CKD was associated with significantly higher all-cause mortality at 1 month (36.6% vs. 23.2%) and 1 year (62.8% vs. 40.5%).
- CKD patients received less inotropic/vasopressor support and mechanical support but more renal replacement therapy (RRT), which independently predicted higher mortality.
Conclusions:
- Cardiogenic shock and CKD are highly prevalent conditions with limited therapeutic options, leading to increased mortality.
- Renal replacement therapy (RRT) is a significant predictor of death in CS patients, irrespective of baseline CKD status.
- Integrated care involving multidisciplinary teams of cardiac and kidney specialists is essential for managing cardiorenal syndrome.
Background:
Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs - the so-called "cardiorenal syndrome". Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce.
Methods:
FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors.
Results:
CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01-1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09-1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status.
Conclusions:
Cardiogenic shock and CKD are frequent "cross-talking" conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.
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