Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease

Bansal, Nisha; Zelnick, Leila R.; Bhat, Zeenat; Dobre, Mirela; He, Jiang; Lash, James P.; Jaar, Bernard G.; Mehta, Rupal; Raj, Dominic S.; Rincon-Choles, Hernan; Saunders, Milda R.; Schrauben, Sarah J.; Weir, Matthew R.; Wright, Julie; Go, Alan S.; Investigators, Cric Study

doi:10.1016/j.jacc.2019.02.071

Cited by 71 publications

(61 citation statements)

References 35 publications

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“…Chronic kidney disease is a known independent risk factor for cardiovascular diseases such as heart failure 95 and myocardial infarction (MI). 96 Likewise, our review of the literature showed that CKD has different effects on in‐hospital outcomes.…”

Section: Factors Affecting Prognosis Of Takotsubo Cardiomyopathymentioning

confidence: 99%

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

Teng

et al. 2021

ESC Heart Failure

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Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this notso-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.

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Section: Factors Affecting Prognosis Of Takotsubo Cardiomyopathymentioning

confidence: 99%

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

Teng

et al. 2021

ESC Heart Failure

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“…One study found that higher numbers of predialysis hospitalizations increased the risk for 1-year mortality, 30 and another found that higher numbers of hospitalizations for heart failure had a graded association with CKD progression and death in individuals with CKD stages 2 to 4. 39 We found that intermediate and high all-cause hospital utilization provided a stepwise increase in the risks of subsequent ESKD and death independent of known risk factors including proteinuria and kidney function. The magnitude of association between high hospital utilization and subsequent ESKD and death remained robust in our sensitivity analyses, where we adjusted for baseline hospitalization status, excluded short-stay hospitalizations (≤1 day), introduced a lag time period, or used less time to form trajectory groups.…”

Section: Discussionmentioning

confidence: 69%

Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Srivastava

Cai

Mehta

et al. 2021

Kidney International Reports

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Introduction Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. Methods We derived cumulative all-cause hospitalization trajectory groups using latent class trajectory analysis in 3012 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were alive and did not reach end-stage kidney disease (ESKD) within 4 years of study entry. Cox proportional hazards models tested the associations between hospitalization trajectory groups and risks of ESKD and death prior to the onset of ESKD (ESKD-censored death). Results Within 4 years of study entry, there were 5658 hospitalizations among 3012 participants. We identified 3 distinct subgroups of individuals with CKD based on cumulative all-cause hospitalization trajectories over 4 years: low-utilizer ( n = 1066), intermediate-utilizer ( n = 1802), and high-utilizer ( n = 144). High-utilizers represented a patient population of lower socioeconomic status who had a greater prevalence of comorbid conditions and lower kidney function compared with intermediate- and low-utilizers. After the 4-year ascertainment period to form the trajectory subgroups, there were 544 ESKD events and 437 ESKD-censored deaths during a median follow-up time of 5.1 years. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.49-fold (95% confidence interval [CI] 1.22–1.84) and 1.75-fold (95% CI 1.20–2.56) higher risk of ESKD in adjusted analyses, respectively. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.48-fold (95% CI 1.17–1.87) and 2.58-fold (95% CI 1.74–3.83) higher risk of ESKD-censored death in adjusted analyses, respectively. Conclusions Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.

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“…Multiple pathophysiological explanations have been proposed in favour of a causal link underlying the adverse cardiovascular profile of CKD patients [1,24]. These include increased intravascular calcium phosphate deposition and coronary artery calcification, [25][26][27] arterial stiffness, enhanced coagulability, endothelial dysfunction, increased subclinical inflammation, [28] volume overload [29], and left ventricular remodeling and dysfunction [30,31]. In addition, patients with CKD undergoing percutaneous coronary intervention for an acute coronary syndrome have been shown to have less complete revascularization, a condition associated with a poorer prognosis [32].…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry

Vidal‐Petiot

Greenlaw

Kalra

et al. 2019

JCM

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Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower-although overall high-rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m 2 ) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0., and <30 mL/min/1.73 m 2 , compared with eGFR ≥90 mL/min/1.73 m 2 . A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.

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Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease

Cited by 71 publications

References 35 publications

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry

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