Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Abstract

Background Cardiorenal programs have emerged to improve the management of cardiorenal disease (CRD). Evidence about the benefits of these programs is still scarce. This work aims to evaluate the performance of a novel cardiorenal program and describe the clinical profile and outcomes of patients with CRD. Methods Retrospective observational study of patients with CRD attended in a Cardiorenal Unit (CRU) from February 2021 to February 2022. Demographics and laboratory tests were collected, and events (all-cause death and cardiovascular hospitalizations) were evaluated. Optimization of comorbidities and protective therapies was also assessed. Results Eighty-two patients were included, with a mean age of 76.8 (SD 8.5) and 72% men. 58.5% (n = 47) had left ventricular ejection fraction less than 50%. The mean follow-up was 11 months (standard deviation (SD) 4.0). Almost fifty-four % of the patients (n = 44) required hospitalization, 30.5% for heart failure (HF) decompensation. Total hospitalizations significantly decreased after CRU inclusion: 0.70 admissions/year vs. 0.45 admissions/year (P < 0.02). Global mortality was 17.1% (n = 14). The percentage of patients with HF with reduced ejection fraction (HFrEF) on quadruple therapy increased by 20%, and up to 60% of the patients were on three drugs. 39% of the patients with HF and preserved ejection fraction started treatment with sodium-glucose cotransporter inhibitors. Hyperkaliemia required the use of potassium binders in 12.2% of the patients, treatment of secondary hyperparathyroidism was started in 42.7%, and renal anemia in 23.2%. Renal replacement therapy was initiated in 10% of the patients (n = 8). Conclusion CRD confers a considerable risk of adverse outcomes. Cardiorenal programs may improve cardiorenal syndrome (CRS) management by optimizing therapies, treating comorbidities, and reducing hospitalizations.