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Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease.
J Am Coll Cardiol. 2019 06 04; 73(21):2691-2700.JACC

Abstract

BACKGROUND

Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited.

OBJECTIVES

This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death.

METHODS

The prospective CRIC (Chronic Renal Insufficiency Cohort) study measured the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) at baseline. The crude rates and rate ratios of HF hospitalizations and 30-day HF re-hospitalizations were calculated using Poisson regression models. Cox regression was used to assess the association of the frequency of HF hospitalizations within the first 2 years of follow-up with risk of subsequent CKD progression and death.

RESULTS

Among 3,791 participants, the crude rate of HF admissions was 5.8 per 100 person-years (with higher rates of HF with preserved ejection fraction vs. HF with reduced ejection fraction). The adjusted rate of HF was higher with a lower eGFR (vs. eGFR >45 ml/min/1.73 m2); the rate ratios were 1.7 and 2.2 for eGFR 30 to 44 and <30 ml/min/1.73 m2 (vs. >45 ml/min/1.73 m2), respectively. Similarly, the adjusted rates of HF hospitalization were significantly higher in those with higher urine ACR (vs. urine ACR <30 mg/g); the rate ratios were 1.9 and 2.6 for urine ACR 30 to 299 and ≥300 mg/g, respectively. Overall, 20.6% of participants had a subsequent HF re-admission within 30 days. HF hospitalization within 2 years of study entry was associated with greater adjusted risks for CKD progression (1 hospitalization: hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.40 to 2.67; 2+ hospitalizations: HR: 2.14; 95% CI: 1.30 to 3.54) and all-cause death (1 hospitalization: HR: 2.20; 95% CI: 1.71 to 2.84; 2+ hospitalizations: HR: 3.06; 95% CI: 2.23 to 4.18).

CONCLUSIONS

Within a large U.S. CKD population, the rates of HF hospitalizations and re-hospitalization were high, with even higher rates across categories of lower eGFR and higher urine ACR. Patients with CKD hospitalized with HF had greater risks of CKD progression and death. HF prevention and treatment should be a public health priority to improve CKD outcomes.

Authors+Show Affiliations

Department of Medicine, University of Washington, Seattle, Washington. Electronic address: nbansal@nephrology.washington.edu.Department of Medicine, University of Washington, Seattle, Washington.Department of Medicine, Wayne State University, Detroit, Michigan.Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.Department of Medicine, Tulane University, New Orleans, Louisiana.Department of Medicine, Jesse Brown VAMC and University of Illinois Hospital and Health Sciences Center, Chicago, Illinois.Department of Medicine, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Northwestern University, Evanston, Illinois.Department of Medicine, George Washington University, Washington, DC.Department of Medicine, Cleveland Clinic, Cleveland, Ohio.Department of Medicine, University of Chicago, Chicago, Illinois.Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Department of Medicine, University of Maryland, College Park, Maryland.Department of Medicine, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Kaiser Permanente Northern California, Division of Research, Oakland, California; Department of Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine, Stanford University School of Medicine, Palo Alto, California.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31146814

Citation

Bansal, Nisha, et al. "Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease." Journal of the American College of Cardiology, vol. 73, no. 21, 2019, pp. 2691-2700.
Bansal N, Zelnick L, Bhat Z, et al. Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. J Am Coll Cardiol. 2019;73(21):2691-2700.
Bansal, N., Zelnick, L., Bhat, Z., Dobre, M., He, J., Lash, J., Jaar, B., Mehta, R., Raj, D., Rincon-Choles, H., Saunders, M., Schrauben, S., Weir, M., Wright, J., & Go, A. S. (2019). Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. Journal of the American College of Cardiology, 73(21), 2691-2700. https://doi.org/10.1016/j.jacc.2019.02.071
Bansal N, et al. Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. J Am Coll Cardiol. 2019 06 4;73(21):2691-2700. PubMed PMID: 31146814.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. AU - Bansal,Nisha, AU - Zelnick,Leila, AU - Bhat,Zeenat, AU - Dobre,Mirela, AU - He,Jiang, AU - Lash,James, AU - Jaar,Bernard, AU - Mehta,Rupal, AU - Raj,Dominic, AU - Rincon-Choles,Hernan, AU - Saunders,Milda, AU - Schrauben,Sarah, AU - Weir,Matthew, AU - Wright,Julie, AU - Go,Alan S, AU - ,, PY - 2018/11/23/received PY - 2019/02/19/revised PY - 2019/02/26/accepted PY - 2019/6/1/entrez PY - 2019/5/31/pubmed PY - 2020/4/3/medline KW - chronic kidney disease KW - end-stage renal-disease KW - heart failure KW - mortality KW - outcomes SP - 2691 EP - 2700 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 73 IS - 21 N2 - BACKGROUND: Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. OBJECTIVES: This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death. METHODS: The prospective CRIC (Chronic Renal Insufficiency Cohort) study measured the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) at baseline. The crude rates and rate ratios of HF hospitalizations and 30-day HF re-hospitalizations were calculated using Poisson regression models. Cox regression was used to assess the association of the frequency of HF hospitalizations within the first 2 years of follow-up with risk of subsequent CKD progression and death. RESULTS: Among 3,791 participants, the crude rate of HF admissions was 5.8 per 100 person-years (with higher rates of HF with preserved ejection fraction vs. HF with reduced ejection fraction). The adjusted rate of HF was higher with a lower eGFR (vs. eGFR >45 ml/min/1.73 m2); the rate ratios were 1.7 and 2.2 for eGFR 30 to 44 and <30 ml/min/1.73 m2 (vs. >45 ml/min/1.73 m2), respectively. Similarly, the adjusted rates of HF hospitalization were significantly higher in those with higher urine ACR (vs. urine ACR <30 mg/g); the rate ratios were 1.9 and 2.6 for urine ACR 30 to 299 and ≥300 mg/g, respectively. Overall, 20.6% of participants had a subsequent HF re-admission within 30 days. HF hospitalization within 2 years of study entry was associated with greater adjusted risks for CKD progression (1 hospitalization: hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.40 to 2.67; 2+ hospitalizations: HR: 2.14; 95% CI: 1.30 to 3.54) and all-cause death (1 hospitalization: HR: 2.20; 95% CI: 1.71 to 2.84; 2+ hospitalizations: HR: 3.06; 95% CI: 2.23 to 4.18). CONCLUSIONS: Within a large U.S. CKD population, the rates of HF hospitalizations and re-hospitalization were high, with even higher rates across categories of lower eGFR and higher urine ACR. Patients with CKD hospitalized with HF had greater risks of CKD progression and death. HF prevention and treatment should be a public health priority to improve CKD outcomes. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/31146814/Burden_and_Outcomes_of_Heart_Failure_Hospitalizations_in_Adults_With_Chronic_Kidney_Disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(19)34692-3 DB - PRIME DP - Unbound Medicine ER -