Abstract. The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402. 01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine Ͼ1.4 mg/dl for women and Ͼ1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit Ն40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of Ͻ30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit Ն40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit Ͻ30% ( 2 for trend was 7.37; P ϭ 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.Anemia is a frequent complication of chronic kidney disease (CKD) and is primarily due to failure of erythropoietin production to respond to decreased hemoglobin concentration (1,2). The onset of anemia during the progression of CKD is variable, but it is common after serum creatinine reaches 1.5 mg/dl and increases in prevalence with decreasing creatinine clearance (3,4). At the onset of end-stage renal disease (ESRD), the mean hematocrit is Ͻ30%, despite the use of erythropoietin replacement in over a quarter of new patients (5). A recent report by al- Ahmad et al. (6) found that CKD and anemia are independent risk factors for mortality among patients with heart failure due to left ventricular dysfunction (i.e., an ejection fraction Յ35%) enrolled in the Studies of LV Dysfunction (SOLVD) clinical trial. Increased risk of death was noted among patients with a hematocrit between 35 and 39% as well as those with more severe degrees of anemia. This report is of particular interest given that the prevalence of heart failure was 33% among new ESRD patients (5).Although CKD has been a known risk factor for mortality among patients with heart failure, the findings of al-Ahmad et al. were unexpected, as a contribution of anemia to the risk of death had not been previously reported (7-16). It is possible that the association between anemia and mortality observed in this clinical trial was a consequence of selection of patients for SOLVD, and similar results might not pertain in a more...

Abstract. The risk of progression to ESRD among individuals with cardiovascular disease and chronic kidney disease (CKD) is not well defined. The purpose of this study was to describe the risk of ESRD among patients with cardiovascular disease. Charts were abstracted for randomly selected hospitalized Medicare beneficiaries with a diagnosis of either congestive heart failure (CHF) or acute myocardial infarction (AMI). The prevalence of CKD, based on the estimated modified diet in renal disease GFR of Ͻ60 ml/min per m 2 , was 60.4% of CHF patients and 51.7% of AMI patients. When compared with patients without CKD, the 30-d readmission rate was higher for CHF patients with CKD (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.18 to 2.44) and for AMI patients with CKD (OR, 1.78; 95% CI, 1.17 to 2.70). CHF patients (OR, 1.62; 95% CI, 1.15 to 2.30) and AMI patients (OR, 3.10; 95% CI, 1.98 to 4.84) with CKD were more likely to die during the year after discharge from the hospital. ESRD after discharge occurred in nine of 517 patients with AMI and 24 of 640 patients with CHF. CKD increased the risk of ESRD among CHF patients (OR, 34.5; 95% CI, 4.23 to 279.43) and AMI patients (0 and 3% for those without and with CKD, respectively). At discharge, 18% of AMI patients and 21% of CHF patients with CKD were discharged with a diagnosis of renal disease. CKD is highly prevalent among patients with cardiovascular disease and is associated with increased risk of adverse outcomes, including progression to ESRD. This study suggests that opportunities may exist to improve the detection of CKD in these patients who are hospitalized with cardiovascular disease.

CKD and decreasing hematocrit were frequent among older patients hospitalized for acute myocardial infarction and are independent predictors of subsequent risk of death.