Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population

Abstract

AimsThe epidemiology of the five stages of chronic kidney disease (CKD) in systolic heart failure (HF) patients has predominantly been described in hospitalized White patients, with little known about the prevalence in outpatient Blacks and Hispanics. The purpose of this study was to compare the prevalence of the five stages of CKD by race, ethnicity (Whites, Blacks, and Hispanics), and gender in an outpatient systolic HF population and also to evaluate the impact of CKD on mortality. Methods and resultsWe conducted a prospective study of 1301 patients recruited from two hospital facilities in Louisiana and Florida, USA. All patients were enrolled in a systolic HF disease management programme (HFDMP), which enrolled patients with an ejection fraction of ≤40% by echocardiography. The estimated glomerular filtration rate was calculated using the abbreviated Modification of Diet in Renal Disease Study equation. Patients were classified into five stages of CKD according to the National Kidney Foundation classification system. A total of 338 patients (26%) were found to have CKD. Patients with CKD were older, more likely to be Hispanics, to have less education, New York Heart Association class III, elevated systolic blood pressure, and diabetes. There was no statistical difference in prevalence by gender. Survival was reduced in patients with CKD. ConclusionThe prevalence of CKD in an outpatient systolic HFDMP is high, with over one in four patients affected. CKD patients had significantly lower survival rates compared with patients without CKD.--

The Role of Congestion in Cardiorenal Syndrome Type 2: New Pathophysiological Insights into an Experimental Model of Heart Failure

“…CRS type 2 (CRS2) is characterized by chronic abnormalities of cardiac function leading to kidney injury or dysfunction [2,3]. It is difficult to extract specific mechanisms for CRS2 based on human studies, which are mainly observational.…”

“…Therefore, animal studies may provide important insights into the pathogenesis of CRS2 by mimicking human phenotypes. The predominant mechanisms proposed include neurohormonal activation, hemodynamic factors such as renal hypoperfusion and venous congestion as well as inflammation and oxidative stress [2,3,4,5]. …”

Epidemiology and outcome of the cardio-renal syndrome

“…Observational data clearly show that chronic heart and kidney disease commonly co-exist [32]. This often creates difficulty for determining which disease process was primary versus secondary.…”

“…First, observational data may be prone to bias and may fail to account for residual or uncontrolled confounding. Second, patients with CKD have often been excluded from clinical trials of interventions in CVD [2] and may receive less or suboptimal risk modifying and/or cardio-protective therapies [32]. Finally, the genuine concern for treatment toxicities, intolerance and/or risks in CKD patients or AKI may be such that therapy is not offered due to an unfounded perception of a less favorable risk-benefit ratio.…”

Cardiorenal Syndrome in Western Countries: Epidemiology, Diagnosis and Management Approaches

“…2 ); the temporal relationship between heart and kidney disease is an epidemiological and pathophysiological aspect of the definition itself. CKD has been observed in 45-63% of chronic heart failure (CHF) patients [11] , but it is unclear how to classify these patients, which often include those shifting from a clinical condition of type 1 CRS [12].…”