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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Worsening heart failure events in adults with mild-to-moderate chronic kidney disease
Linda Ye1, Michael P Girouard2, Alan S Go3
1Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA.
Insights
Worsening heart failure (WHF) is common in adults with mild-to-moderate chronic kidney disease (CKD). Higher event rates were observed with lower estimated glomerular filtration rate (eGFR) and greater albuminuria, highlighting the need for cardioprotective therapies.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Chronic kidney disease (CKD) is a significant risk factor for heart failure (HF).
- The specific burden of worsening heart failure (WHF) events in individuals with mild-to-moderate CKD remains under-described.
Purpose of the Study:
- To evaluate the incidence and burden of WHF events in a contemporary cohort of adults diagnosed with mild-to-moderate CKD.
Main Methods:
- A cohort of adults with mild-to-moderate CKD (eGFR 30-59 mL/min/1.73m² or eGFR ≥60 mL/min/1.73m² with albuminuria) was identified between 2012 and 2021.
- Outcomes included hospitalizations, emergency department visits, and outpatient encounters for WHF.
- Data were stratified by prior heart failure status and CKD severity.
Main Results:
- The study included 375,495 adults with mild-to-moderate CKD.
- The cumulative rate of WHF events was 2.42 per 100 person-years, with hospitalizations being the most frequent (1.85 per 100 person-years).
- WHF event rates increased significantly with lower estimated glomerular filtration rate (eGFR) and higher levels of albuminuria.
Conclusions:
- Worsening heart failure represents a substantial source of morbidity in adults with earlier stages of CKD.
- Individuals with lower eGFR and increased albuminuria face a particularly high risk of WHF events.
- These findings emphasize the critical need for implementing cardioprotective and renoprotective strategies in this high-risk population.
Background:
Chronic kidney disease (CKD) is a major risk factor for heart failure (HF). However, the burden of worsening HF (WHF) events among adults with mild-to-moderate CKD has not been well described.
Objectives:
This study assessed the burden of WHF in a contemporary cohort of adults with mild-to-moderate CKD.
Methods:
We identified adults with mild-to-moderate CKD (eGFR 30-59 mL/min/1.73m² or eGFR ≥60 mL/min/1.73m² with albuminuria) within a large, integrated healthcare delivery system from 2012 to 2021. Outcomes included hospitalizations, emergency department visits, and outpatient encounters for WHF, stratified by HF status and level of CKD.
Results:
Among 375,495 adults with mild-to-moderate CKD, mean age was 64 ± 16 years, 54% were women, mean eGFR was 76 ± 26 mL/min/1.73m², and 6.5% had prior known HF. CKD stages G1A2 (31.6%), G2A2 (24.9%), and G3aA1 (25.1%) were most prevalent. Rates (95% CI) per 100 person-years for WHF events were 1.85 (1.83-1.87) for hospitalizations, 0.85 (0.84-0.86) for emergency department visits, and 0.83 (0.81-0.84) for outpatient encounters, resulting in a cumulative rate of 2.42 (2.40-2.44). Event rates were higher at lower eGFR and higher albuminuria levels.
Conclusions:
WHF is a common source of morbidity in adults with earlier stage CKD, and particularly high in those with lower eGFR and greater albuminuria. These findings underscore the importance of implementing available and emerging cardioprotective and renoprotective therapies in this high-risk population.
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