Heart failure patients at high risk of developing kidney failure

USA: Cardiovascular disease (CVD), independent of kidney risk factors, increases the risk of developing kidney failure, finds a recent study published in the Journal of the American Society of Nephrology. Heart failure was associated with the highest risk --- participants hospitalized with heart failure had an 11.4-times higher risk of developing kidney failure than participants without cardiovascular disease.

The findings, highlight the importance of monitoring and managing kidney disease in patients diagnosed with CVD.

Cardiorenal syndrome (CRS), that defines inter dependability of heart and kidney health, is a well-known concept. It is bolstered by extensive investigations of chronic kidney disease (CKD) as a risk factor of cardiovascular disease. However, there is a sparse data on whether CVD increases long-term risk of end-stage kidney disease (ESKD).

Kunihiro Matsushita, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues assessed the association of incident hospitalization with major cardiovascular diseases (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESKD among individuals enrolled in the Atherosclerosis Risk in Communities study.

The analysis included 9047 people with prevalent CVD at their fourth study visit. Each relevant incident cardiovascular disease event was entered into multivariable Cox proportional hazard models as a time-varying exposure to estimate hazard ratios.

"Many physicians probably recognize that patients with cardiovascular disease are at risk of kidney disease progression, but to my knowledge, this is the first study quantifying the contribution of different cardiovascular diseases to the development of kidney failure," said Dr. Matsushita.

Key findings of the study include:

• During a median follow-up of 17.5 years, there were 2598 cases of hospitalization with cardiovascular disease (heart failure, n=1269; atrial fibrillation, n=1337; coronary heart disease, n=696; and stroke, n=559) and 210 cases of incident ESKD.


• The incidence of major cardiovascular disease was associated with increased risk of ESKD, with the highest risk for heart failure (hazard ratio, 11.40), followed by coronary heart disease, atrial fibrillation, and stroke.


• When we analyzed heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately, the risk was nominally higher for heart failure with preserved ejection fraction.

"Individuals with a history of cardiovascular disease should be recognized as a high-risk population for kidney failure. In this context, physicians should be aware of cardiovascular disease as an important risk condition, and thereby minimize treatments that are toxic to the kidneys in such individuals," said Dr. Ishigami. "Additionally, our findings may have implications for monitoring kidney function, although current cardiovascular disease guidelines do not necessarily specify the frequency of evaluating kidney function following the incidence of cardiovascular disease."

The study, "Incident Hospitalization with Major Cardiovascular Diseases and Subsequent Risk of ESKD: Implications for Cardiorenal Syndrome," is published in the Journal of the American Society of Nephrology.

DOI: https://doi.org/10.1681/ASN.2019060574