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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
CaReMe-CKD-HF-Epidemiology of Heart Failure in Chronic Kidney Disease: A Retrospective Analysis of Routine
Lars Stellmacher1,2,3, Sebastian König1,2, Johannes Leiner1,2
1Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany.
Insights
Heart failure (HF) is common in chronic kidney disease (CKD) patients in Germany, significantly increasing their risk of death and hospital readmissions. This highlights the need for better prevention and management strategies for HF in CKD.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Heart failure (HF) is a significant comorbidity in patients with chronic kidney disease (CKD).
- The interplay between HF and CKD involves complex hemodynamic, neurohormonal, and inflammatory pathways.
- Nationwide epidemiological data on hospitalized CKD patients with HF in Germany are limited.
Purpose of the Study:
- To determine the prevalence of HF in hospitalized CKD patients in Germany.
- To investigate the outcomes associated with HF in this patient population.
- To utilize a large, real-world dataset for epidemiological analysis.
Main Methods:
- Retrospective observational study using administrative data from 87 German hospitals (2016-2022).
- Analysis of 48,011 CKD index cases, stratified into CKD with HF (46%) and CKD without HF (54%).
- Inclusion of electronic medical records from 23,377 CKD patients and consideration of all hospital readmissions.
Main Results:
- CKD patients with HF were older, had more comorbidities, and poorer renal function.
- In-hospital mortality was significantly higher in CKD-HF patients (16.5%) compared to CKD-no-HF (6.7%).
- CKD-HF patients experienced earlier and more frequent readmissions, with increased follow-up mortality (13.3% vs. 8.7%).
Conclusions:
- HF is highly prevalent in CKD patients in Germany.
- The presence of HF substantially increases morbidity and mortality in CKD.
- Urgent need for targeted prevention and management strategies for HF in CKD patients is evident.
Background:
Heart failure (HF) is a frequent and clinically relevant comorbidity in patients with chronic kidney disease (CKD). Both conditions are closely linked through hemodynamic, neurohormonal, and inflammatory mechanisms, resulting in excess morbidity and mortality. However, nationwide epidemiological data for hospitalized patients with CKD in Germany are scarce. This study aimed to determine the prevalence and outcomes of HF in CKD using a large real-world dataset.
Materials And Methods:
We conducted a retrospective, observational study analyzing administrative data from 87 German hospitals between 2016 and 2022 (n = 48,011 CKD index cases). Patients were stratified into CKD with HF (n = 22,085; 46%) and CKD without HF (n = 25,926; 54%). Additional electronic medical records (EMR) from 23,377 CKD patients of the Heart Center Leipzig were included. All hospital readmissions were considered during the follow-up period. Comparative statistics are presented for each group.
Results:
CKD patients with HF were older (76.5 ± 10.8 vs. 71.5 ± 14.3 years, p < 0.001), more frequently affected by cardiovascular and metabolic comorbidities, and had worse renal function. In-hospital mortality was higher in CKD-HF than CKD-no-HF patients (16.5% vs. 6.7%; odds ratio [OR] 2.73, 95% CI 2.58-2.89; p < 0.001). During follow-up, readmissions occurred earlier (175 ± 266 vs. 212 ± 309 days, p < 0.001) and more frequently in the CKD-HF group (20.3 vs. 17.7 events per 100 patient-years). Follow-up in-hospital mortality was also increased in CKD-HF patients (13.3% vs. 8.7%; OR 1.62, 95% CI 1.52-1.73; p < 0.001).
Discussion:
In this large, multicenter, real-world cohort, HF was highly prevalent in CKD and associated with substantially increased morbidity and mortality. These findings highlight the considerable public health burden of HF in CKD and the urgent need for targeted prevention and management strategies.
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