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Chronic kidney disease, worsening renal function and outcomes in a heart failure community setting: A UK national study
journal contributionposted on 2018-09-12, 13:35 authored by Claire A. Lawson, J. M. Testani, M. Mamas, K. Damman, P. W. Jones, L. Teece, U. T. Kadam
Background Routine heart failure (HF) monitoring and management is in the community but the natural course of worsening renal function (WRF) and its influence on HF prognosis is unknown. We investigated the influence of routinely monitored renal decline and related comorbidities on imminent hospitalisation and death in the HF community population. Methods A nested case-control study within an incident HF cohort (N = 50,114) with 12-years follow-up. WRF over 6-months before first hospitalisation and 12-months before death was defined by >20% reduction in estimated glomerular filtration rate (eGFR). Additive interactions between chronic kidney disease (CKD) and comorbidities were investigated. Results Prevalence of CKD (eGFR<60 ml/min/1.73m2) in the HF community was 63%, which was associated with an 11% increase in hospitalisation and 17% in mortality. Both risk associations were significantly worse in the presence of diabetes. Compared to HF patients with eGFR,60–89, there was no or minimal increase in risk for mild to moderate CKD (eGFR,30–59) for both outcomes. Adjusted risk estimates for hospitalisation were increased only for severe CKD(eGFR,15–29); Odds Ratio 1.49 (95%CI;1.36,1.62) and renal failure(eGFR,<15); 3.38(2.67,4.29). The relationship between eGFR and mortality was U-shaped; eGFR, ≥90; 1.32(1.17,1.48), eGFR,15–29; 1.68(1.58,1.79) and eGFR,<15; 3.04(2.71,3.41). WRF is common and associated with imminent hospitalisation (1.50;1.37,1.64) and mortality (1.92;1.79,2.06). Conclusions In HF, the risk associated with CKD differs between the community and the acute HF setting. In the community setting, moderate CKD confers no risk but severe CKD, WRF or CKD with other comorbidities identifies patients at high risk of imminent hospitalisation and death.
This work was supported by (i) a National Institute for Health Research (NIHR, UK) Doctoral Fellowship [grant number NIHR-DRF-2012-05-288]. (ii) Leicester-Wellcome Trust ISSF Fellowship [Reference 204801/Z/16/Z].
CitationInternational Journal of Cardiology, 2018, 267, pp. 120-127 (8)
Author affiliation/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences
- VoR (Version of Record)
Published inInternational Journal of Cardiology
PublisherElsevier, International Society for Adult Congenital Heart Disease
NotesSupplementary data to this article can be found online at https://doi.org/10.1016/j.ijcard.2018.04.090
Science & TechnologyLife Sciences & BiomedicineCardiac & Cardiovascular SystemsCardiovascular System & CardiologyHeart failureChronic kidney diseaseWorsening renal functionComorbidityHospitalisationDeathPopulation basedGLOMERULAR-FILTRATION-RATEREDUCED EJECTION FRACTIONDIABETIC-NEPHROPATHYMEDICAL THERAPYIMPAIRMENTMETAANALYSISOUTPATIENTSDYSFUNCTIONPREDICTORSMORTALITY