Nisha Bansal1, Leila Zelnick2, Zeenat Bhat3, Mirela Dobre4, Jiang He5, James Lash6, Bernard Jaar7, Rupal Mehta8, Dominic Raj9, Hernan Rincon-Choles10, Milda Saunders11, Sarah Schrauben12, Matthew Weir13, Julie Wright14, Alan S Go15. 1. Department of Medicine, University of Washington, Seattle, Washington. Electronic address: nbansal@nephrology.washington.edu. 2. Department of Medicine, University of Washington, Seattle, Washington. 3. Department of Medicine, Wayne State University, Detroit, Michigan. 4. Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. 5. Department of Medicine, Tulane University, New Orleans, Louisiana. 6. Department of Medicine, Jesse Brown VAMC and University of Illinois Hospital and Health Sciences Center, Chicago, Illinois. 7. Department of Medicine, Johns Hopkins University, Baltimore, Maryland. 8. Department of Medicine, Northwestern University, Evanston, Illinois. 9. Department of Medicine, George Washington University, Washington, DC. 10. Department of Medicine, Cleveland Clinic, Cleveland, Ohio. 11. Department of Medicine, University of Chicago, Chicago, Illinois. 12. Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 13. Department of Medicine, University of Maryland, College Park, Maryland. 14. Department of Medicine, University of Michigan, Ann Arbor, Michigan. 15. 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.
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.
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: Andrew S Levey; Josef Coresh; Tom Greene; Jane Marsh; Lesley A Stevens; John W Kusek; Frederick Van Lente Journal: Clin Chem Date: 2007-03-01 Impact factor: 8.327
Authors: Marshall Joffe; Chi-yuan Hsu; Harold I Feldman; Matthew Weir; J R Landis; L Lee Hamm Journal: Am J Nephrol Date: 2010-04-14 Impact factor: 3.754
Authors: Harold I Feldman; Lawrence J Appel; Glenn M Chertow; Denise Cifelli; Borut Cizman; John Daugirdas; Jeffrey C Fink; Eunice D Franklin-Becker; Alan S Go; L Lee Hamm; Jiang He; Tom Hostetter; Chi-Yuan Hsu; Kenneth Jamerson; Marshall Joffe; John W Kusek; J Richard Landis; James P Lash; Edgar R Miller; Emile R Mohler; Paul Muntner; Akinlolu O Ojo; Mahboob Rahman; Raymond R Townsend; Jackson T Wright Journal: J Am Soc Nephrol Date: 2003-07 Impact factor: 10.121
Authors: James P Lash; Alan S Go; Lawrence J Appel; Jiang He; Akinlolu Ojo; Mahboob Rahman; Raymond R Townsend; Dawei Xie; Denise Cifelli; Janet Cohan; Jeffrey C Fink; Michael J Fischer; Crystal Gadegbeku; L Lee Hamm; John W Kusek; J Richard Landis; Andrew Narva; Nancy Robinson; Valerie Teal; Harold I Feldman Journal: Clin J Am Soc Nephrol Date: 2009-06-18 Impact factor: 8.237
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Anna Kottgen; Stuart D Russell; Laura R Loehr; Ciprian M Crainiceanu; Wayne D Rosamond; Patricia P Chang; Lloyd E Chambless; Josef Coresh Journal: J Am Soc Nephrol Date: 2007-03-07 Impact factor: 10.121
Authors: Harlan M Krumholz; Angela R Merrill; Eric M Schone; Geoffrey C Schreiner; Jersey Chen; Elizabeth H Bradley; Yun Wang; Yongfei Wang; Zhenqiu Lin; Barry M Straube; Michael T Rapp; Sharon-Lise T Normand; Elizabeth E Drye Journal: Circ Cardiovasc Qual Outcomes Date: 2009-07-09
Authors: Yogesh N V Reddy; Masaru Obokata; Aaron D Jones; Gregory D Lewis; Sanjiv J Shah; Omar F Abouezzedine; Marat Fudim; Brooke Alhanti; Lynne W Stevenson; Margaret M Redfield; Barry A Borlaug Journal: J Card Fail Date: 2020-08-19 Impact factor: 5.712
Authors: Jesse K Fitzpatrick; Andrew P Ambrosy; Rishi V Parikh; Thida C Tan; Nisha Bansal; Alan S Go Journal: Am Heart J Date: 2022-03-10 Impact factor: 4.749
Authors: Alberto Ortiz; Juan F Navarro-González; Julio Núñez; Rafael de la Espriella; Marta Cobo; Rafael Santamaría; Patricia de Sequera; Javier Díez Journal: Clin Kidney J Date: 2021-12-23
Authors: Gwen M Bernacki; Cara L McDermott; Daniel D Matlock; Ann M O'Hare; Lyndia Brumback; Nisha Bansal; James N Kirkpatrick; Ruth A Engelberg; Jared Randall Curtis Journal: J Pain Symptom Manage Date: 2021-08-04 Impact factor: 3.612
Authors: Yao Qiao; Jung-Im Shin; Teresa K Chen; Yingying Sang; Josef Coresh; Joseph A Vassalotti; Alex R Chang; Morgan E Grams Journal: Hypertension Date: 2020-09-28 Impact factor: 9.897
Authors: Anand Srivastava; Xuan Cai; Rupal Mehta; Jungwha Lee; David I Chu; Katherine T Mills; Tariq Shafi; Jonathan J Taliercio; Jesse Y Hsu; Sarah J Schrauben; Milda R Saunders; Clarissa J Diamantidis; Chi-Yuan Hsu; Sushrut S Waikar; James P Lash; Tamara Isakova Journal: Kidney Int Rep Date: 2021-03-31