Chronic kidney disease, worsening renal function and outcomes in a heart failure community setting: A UK national study

Abstract

BackgroundRoutine 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.MethodsA 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.ResultsPrevalence 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).ConclusionsIn 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.

Association Between the Lipid Profile and Renal Dysfunction in the Heart Failure Patients

“…Previous studies have demonstrated high prevalence of renal dysfunction in heart failure patients [6-8]. A recent UK national study has documented the prevalence of CKD (eGFR< 60 ml/ min·1.73m 2 ) in the HF community is 63% [5]. Whilst the high prevalence of CKD in the community HF population is consist with that in hospital [19] and other specialist care settings [20].…”

“…Cole RT et al [4] reviewed that 20% to 57% patients with chronic, stable HF and 30% to 67% patients with acutely decompensated HF had certain levels of renal dysfunction. According to a recent large sample UK study based on the 50, 114 heart failure patients, the prevalence of CKD in the HF community was 63%, it brought an 11% increase in hospitalization and 17% in mortality in heart failure patients [5]. The pathophysiological features have demonstrated that heart failure may cause the reduction in cardiac output and decrease in renal perfusion, which have became the primary driver for renal dysfunction in HF [6-8].…”

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

“…In AHF, the dysfunction of heart and kidney resulting in a cascade of feedback mechanism causing damage to both organs and developing cardiorenal syndrome (CRS), which led to acute kidney injury (AKI) chronic kidney disease (CKD), and/or worsening renal function (WRF). [ 2 , 3 ] Despite recent advances in management and treatment, it remains one of the most important comorbidities in HF patients and is associated with adverse clinical outcomes.…”

“…The association between GFR and risk of mortality in patients with AHF has shown in various studies. [ 2 , 4 ] Accurate measurement of patient's renal function is critical to optimal management. The “gold standard” for GFR determination is to measure the clearance of exogenous substances, but these measurements are usually time-consuming and complicated for routine clinical practice.…”

Aortic Stiffness and Heart Failure in Chronic Kidney Disease

“…CKD is present in approximately one-third of patients with HF [3]. According to the latest reports, the prevalence of CKD in HF might be even higher, ranging from 50 to 63% [4,5]. Presence of both diseases, HF and CKD, is strongly related to worse prognosis, including increased risk of hospitalization, all-cause mortality, and CV mortality [4-6, 7•].…”