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Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors
J D Harnett1, R N Foley, G M Kent
1Division of Nephrology and Clinical Epidemiology, Memorial University of Newfoundland, Montreal, Canada.
Insights
Congestive heart failure (CHF) is prevalent in dialysis patients, with risk factors including systolic dysfunction and older age. Identifying these factors is key to improving outcomes and survival for this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Cardiovascular disease is the leading cause of mortality in dialysis patients.
- Congestive heart failure (CHF) is a frequent manifestation of cardiovascular disease in this population.
- Understanding CHF prevalence, incidence, risk factors, and prognosis is vital for intervention planning.
Purpose of the Study:
- To investigate the prevalence, incidence, risk factors, and recurrence of congestive heart failure (CHF) in dialysis subjects.
- To identify predictors of CHF development and recurrence.
- To assess the impact of CHF on survival in dialysis patients.
Main Methods:
- Prospective, multicenter cohort study involving 432 dialysis patients.
- Follow-up duration averaged 41 months.
- Data collected on risk factors, with annual echocardiography and clinical assessments.
Main Results:
- 31% of patients had CHF at baseline; 25% developed incident CHF during follow-up.
- Baseline CHF risk factors included systolic dysfunction, older age, diabetes, and ischemic heart disease.
- Risk factors for developing CHF included older age, anemia, hypoalbuminemia, hypertension, and systolic dysfunction.
- Recurrent CHF was associated with ischemic heart disease, systolic dysfunction, anemia, and hypoalbuminemia.
- Median survival was significantly lower for patients with CHF at baseline (36 months) compared to those without (62 months).
Conclusions:
- The prevalence and incidence of CHF are high in end-stage renal disease (ESRD) patients starting dialysis.
- Systolic dysfunction, older age, diabetes, ischemic heart disease, anemia, hypoalbuminemia, and hypertension are significant risk factors for CHF in dialysis patients.
- CHF significantly impacts survival in the dialysis population, underscoring the need for targeted management strategies.
Abstract:
Cardiovascular disease is the most common cause of death in dialysis subjects. Congestive heart failure (CHF) is a common presenting symptom of cardiovascular disease in the dialysis population. Information regarding prevalence, incidence, risk factors and prognosis is crucial for planning rational interventional studies. A prospective multicenter cohort study of 432 dialysis patients followed for a mean of 41 months was carried out. Prospective information on a variety of risk factors was collected. Annual echocardiography and clinical assessment was performed. Major endpoints included death and the development of morbid cardiovascular events. One hundred and thirty-three (31%) subjects had CHF at the time of initiation of dialysis therapy. Multivariate analysis showed that the following risk factors were significantly and independently associated with CHF at baseline: systolic dysfunction, older age, diabetes mellitus and ischemic heart disease. Seventy-six of 299 subjects (25%) who did not have baseline CHF subsequently developed CHF during their course on dialysis. Compared to those subjects who never developed CHF (N = 218) multivariate analysis identified the following risk factors for the development of CHF: older age, anemia during dialysis therapy, hypoalbuminemia, hypertension during dialysis therapy, and systolic dysfunction. Seventy-five of the 133 (56%) subjects with CHF at baseline had recurrent CHF during follow-up. Independent and significant risk factors for CHF recurrence were ischemic heart disease and systolic dysfunction, anemia during dialysis therapy and hypoalbuminemia. The median survival of subjects with CHF at baseline was 36 months compared to 62 months in subjects without CHF. In this study the prevalence of CHF on starting ESRD therapy and the subsequent annual incidence was high.(ABSTRACT TRUNCATED AT 250 WORDS)