Author + information
- Helle Skovmand Bosselmann,
- Gunnar H. Gislason,
- Per Hildebrandt,
- Finn Gustafsson,
- Lars Videbaek,
- Lars Koeber,
- Christian Torp–Pedersen,
- Niels Toender,
- Kasper Rossing,
- Stefan Christensen,
- Anne–Lise Kamper,
- James Heaf and
- Morten Schou
Renal dysfunction is a prognostic factor in heart failure (HF) and is associated with an increased mortality risk and increased risk for re–admission. We examined risk and predictors of end–stage renal disease (ESRD) requiring renal replacement therapy in patients with HF followed in outpatient HF clinic.
Patients with systolic HF were identified in The Danish Heart Failure Clinics Network database and new–onset ESRD from the Danish National Registry and Dialysis and Transplantation from 2002–2011. Patients with ESRD prior to referral to a HF clinic were excluded. Renal function was estimated by the Modification of Diet in Renal Disease Formula and patients grouped by eGFR according to Chronic Kidney Disease (CKD) stages: stage I+II: >60 ml/min/1.73m2, stage III: 60–30 ml/min/1.73m2, stage IV: 30–15 ml/min/1.73m2, stage V: <15 ml/min/1.73m2. Cox Proportional Hazard Models for time to ESRD, time to death or time to the combined endpoint of ESRD or death were constructed and predictors for ESRD identified.
A total of 8,204 patients were included in the analyses. Median age was 70 years (IQR 61–77), 28% were female, median left ventricular ejection fraction 30% (IQR 24–40) and median eGFR was 68 (IQR 51–85) ml/min/1.73m2. 41 patients developed ESRD (0.5% and 4.3 per 1000 years of follow up). Baseline CKD stage III (HR 10.9; 95% CI: 3.0–40.8, P<0.001), CKD stage IV (HR 246.9; 95%CI: 66.3–914.6, P<0.001), CKD stage V (HR 996.4; 95%CI: 211.2–4499.9) hypertension (HR 2.1; 95% CI: 1.1–4.0, P=0.033) and age < 60 (HR 2.9, 95% CI: 1.3–6.3 P=0.007) were associated with time to ESRD. A total of 2,652 patients died (32.3 % and 101 per 1000 years of follow up). CKD stage III (HR 1.4; 95% CI: 1.3–1.5, P<0.001), CKD stage IV (HR 2.0; 95% CI: 1.8–2.4, P<0.001) and CKD stage V (HR 2.7; 95% CI: 1.7–4.3, P<0.001), diabetes (HR 1.3; 95% CI: 1.1–1.4, P<0.001) and age >70 (HR 1.7; 95% CI: 1.6–1.9, P<0.001) were associated with time to death or ESRD.
ESRD is rare in outpatients with systolic HF and progression to ESRD is mainly observed in patients in CKD stage IV and V at the baseline visit in the HF clinic. CKD stage, age <60 years and hypertension identify patients with an increased risk for ESRD.
Special Session North, Room 120
Monday, March 11, 2013, 8:15 a.m.–8:30 a.m.
Session Title: Young Investigator Awards Competition: Clinical Investigations, Congenital Heart Disease, and Cardiovascular Surgery
Abstract Category: Clinical Investigations, Congenital Heart Disease, Cardiac Surgery
Presentation Number: 408–5
- 2013 American College of Cardiology Foundation