Author + information
- Received November 23, 2018
- Revision received February 19, 2019
- Accepted February 26, 2019
- Published online May 27, 2019.
- Nisha Bansal, MDa,∗ (, )@KidneyResInst,
- Leila Zelnick, PhDa,
- Zeenat Bhat, MDb,
- Mirela Dobre, MDc,
- Jiang He, MDd,
- James Lash, MDe,
- Bernard Jaar, MDf,
- Rupal Mehta, MDg,
- Dominic Raj, MDh,
- Hernan Rincon-Choles, MDi,
- Milda Saunders, MDj,
- Sarah Schrauben, MDk,
- Matthew Weir, MDl,
- Julie Wright, MDm,
- Alan S. Go, MDn,o,p,
- for the CRIC Study Investigators
- aDepartment of Medicine, University of Washington, Seattle, Washington
- bDepartment of Medicine, Wayne State University, Detroit, Michigan
- cDepartment of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- dDepartment of Medicine, Tulane University, New Orleans, Louisiana
- eDepartment of Medicine, Jesse Brown VAMC and University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
- fDepartment of Medicine, Johns Hopkins University, Baltimore, Maryland
- gDepartment of Medicine, Northwestern University, Evanston, Illinois
- hDepartment of Medicine, George Washington University, Washington, DC
- iDepartment of Medicine, Cleveland Clinic, Cleveland, Ohio
- jDepartment of Medicine, University of Chicago, Chicago, Illinois
- kDepartment of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- lDepartment of Medicine, University of Maryland, College Park, Maryland
- mDepartment of Medicine, University of Michigan, Ann Arbor, Michigan
- nDepartment of Medicine, Kaiser Permanente Northern California, Division of Research, Oakland, California
- oDepartment of Medicine, University of California-San Francisco, San Francisco, California
- pDepartment of Medicine, Stanford University School of Medicine, Palo Alto, California
- ↵∗Address for correspondence:
Dr. Nisha Bansal, Kidney Research Institute, University of Washington, 908 Jefferson St, 3rd Floor, Seattle, Washington 98104.
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.
Dr. Bansal was supported by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) (grant R01DK103612) and an unrestricted fund from the Northwest Kidney Centers. The CRIC Study was supported under a cooperative agreement from NIDDK (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). This study was also supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award (NIH/NCATS UL1TR000003), Johns Hopkins University (UL1 TR-000424), University of Maryland (GCRC M01 RR-16500), Clinical and Translational Science Collaborative of Cleveland (UL1TR000439) from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research (MICHR) (UL1TR000433), University of Illinois at Chicago CTSA (UL1RR029879), Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases (P20 GM109036), and Kaiser Permanente (NIH/NCRR UCSF-CTSI UL1 RR-024131). Dr. Zelnick has been a consultant for Microsoft. Dr. Mehta owns stock in Abbot Laboratories, AbbVie Inc., and Teva Pharmaceuticals. Dr. Go has received research funding from Novartis and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 23, 2018.
- Revision received February 19, 2019.
- Accepted February 26, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.