Interim Heart Failure Increases Risk of Chronic Kidney Disease Mortality

Silvia J. Leon Mantilla

A new analysis shows how interim heart failure (HF) increases the risk of mortality and other negative outcomes for patients with chronic kidney disease (CKD).

A team, led by Silvia J. Leon Mantilla, Seven Oaks General Hospital, determined whether heart failure is a risk factor for adverse renal outcomes and mortality in patients with CKD. The team also quantified the magnitude of its effect.

Heart Failure and Chronic Kidney Disease

Both heart failure and chronic kidney disease are interlinked through multifaceted inter-organ cross-talk that increases the risk of the co-existence of both conditions. Both diseases separately, as well as in combination, are linked to high symptom burdens, an increased mortality risk, and increased healthcare costs.

In the retrospective cohort study, the investigators used administrative health data from Manitoba, Canada of adult patients with prevalent CKD between January 1, 2007 and January 1, 2018. The team defined CKD as by KDIGO using CDK-EPI eGFR <60 mL/min/1.73 m² and/or proteinuria for over 3 months.

The data was presented during the 2022 American Society of Nephrology (ASN) Annual Meeting in Orlando.

Looking at Patients

The investigators identified a subgroup of patients with heart failure at baseline and examined the association of an interim heart failure event as time-dependent exposure with study outcomes using time-dependent Cox models adjusted for demographics, comorbidities, eGFR, UACR, and medications.

The team sought primary composite outcomes of ≥40% decline in estimated glomerular filtration rate (eGFR), renal replacement therapy (chronic dialysis or kidney transplant), or all-cause mortality: DD40 events.

The study included 18,880 total patients with CKD, 19% (n = 3650) of which had a history of heart failure at baseline. The mean eGFR was 51 ± 26 mL/min/1/.73m², while the median UACR was 6.20 mg/mmol (IQR: 1.4 - 32.4).

In addition, 24% (n = 4546) of patients had at least 1 interim heart failure event, with a median time to first interim heart failure event of 1.9 years.

In the time-dependent analysis, patients with heart failure at baseline were more likely to have DD40 events and its components after an interim heart failure event compared to patients without interim heart failure events adjusted hazard risk for DD40 (aHR, 1.98; 95% CI, 1.81-2.17).

The results also show individuals without heart failure at baseline, interim heart failure hospitalization was linked to a higher risk of DD40 events compared to patients without interim heart failure events (aHR; 1.59; 95% CI, 1.50-1.69).

“Interim heart failure is associated with an increased risk of a composite outcome of all-cause mortality, ESKD, and ≥ 40% decline in eGFR in patients with CKD irrespective of history of HF,” the investigators wrote. “These findings strongly support efforts to optimize treatment for primary and secondary prevention of heart failure hospitalizations in patients with CKD.”

The study, “Association Between CKD Progression and Heart Failure: A Retrospective Cohort Study,” was published online by ASN.