Abstract: TH-PO634
Heart Failure: A Risk Factor for Progression to ESKD
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, Prevention
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention
Authors
- Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Ye, Xiangyang, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Sarwal, Amara, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Agarwal, Adhish, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background
Despite much interest in cardiorenal syndrome, there is a paucity of data on whether heart failure (HF) is a risk factor for progression to end-stage kidney disease (ESKD).
Methods
We used the VA Informatics and Computing Infrastructure (VINCI) platform to identify a national cohort of veterans (N=993,929) with CKD stages 3A, 3B or 4 (two or more outpatient CKD-EPI eGFR 15 to <60 ml/min/1.73m2 taken 60 days apart) from January 2010 to December 2015. Index date was defined as the date of second outpatient creatinine with follow-up through June 30, 2018. ICD9/10 codes defined baseline comorbidities and prevalent HF. We identified ESKD by linkage to the US Renal Data System, and mortality from VA CDW data. In separate multivariate Cox regression models, we related baseline HF with time to ESKD alone and a composite of ESKD/ death adjusted for demographics, comorbidities and baseline blood pressure.
Results
19.4% had HF at baseline. The distribution of CKD 3A, 3B and 4 were 68.3%, 25.3% and 6.4% respectively. There were 21,706 ESKD events over 4.7 million person-years of follow-up, 409,539 deaths over 4.6 million person-years and 420,505 ESKD/death events over 4.6 million person-years of follow up. In the entire CKD cohort, HF was significantly associated with higher hazard of ESKD (HR1.27, 95% CI 1.23-1.31) and ESKD/death (HR1.90, 95% CI 1.89-1.92). Compared to those without HF and with stage 3A CKD, those with HF and more advanced CKD had higher risk of ESKD and ESKD/death (Fig 1 and Table).
Conclusion
HF is an independent risk factor for ESKD progression in CKD. Interventions that target HF might slow CKD progression to ESRD.
Adjusted Hazard of ESKD or Composite ESKD/Death
| CKD Stage & Baseline HF Status | HR of ESKD | 95% CI | HR of Composite | 95% CI |
| 3A & No HF | 1 (reference) | -- | 1 (reference) | -- |
| 3A & HF | 1.62 | 1.51-1.73 | 2.02 | 2.00-2.04 |
| 3B & No HF | 4.11 | 3.95-4.28 | 1.40 | 1.39-1.41 |
| 3B & HF | 5.45 | 5.15-5.76 | 2.62 | 2.59-2.65 |
| 4 & No HF | 19.92 | 19.12-20.75 | 2.35 | 2.32-2.38 |
| 4 & HF | 21.82 | 22.71-22.99 | 4.00 | 3.94-4.07 |
Fig.1: ESKD and Composite Outcomes differ by HF and CKD stage (unadjusted Kaplan Meier Curves)
Funding
- NIDDK Support