Abstract: TH-PO710
Incidence of Heart Failure in CKD Patients Is Not Affected by Rurality
Session Information
- Diversity and Equity in Kidney Health - I
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Sammons, Stephen R., University of Utah Health, Salt Lake City, Utah, United States
- Ye, Xiangyang, University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States
- Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
Background
While there is a well-known interplay between Chronic Kidney Disease (CKD) and Heart Failure (HF), little is known about how social determinants of health such as rurality affect this relationship.
Methods
We analyzed a national cohort (n = 740,233) of veterans with CKD and without HF at baseline. Veterans with eGFR < 60 on two consecutive outpatient serum creatinine measurements that were at least 60 days apart from 1/1/2010 to 12/31/2015 were included. The index date was defined as the date of the second eGFR <60. Metropolitan, micropolitan, or small town/rural residences were defined by Rural-Urban Commuting Area (RUCA) codes. HF incidence was defined as the number of new HF diagnoses from index date until 6/30/2018. Cox regression models adjusted for age, gender, and comorbidities were used to relate rurality and CKD categories to the risk of HF.
Results
The distribution of metropolitan, micropolitan, or small town/rural residences were 74.8%, 13.2% and 12.0%, respectively: for CKD 3A, 3B and 4 70.9%, 23.8% and 5.3%, respectively. There were 116,298 HF events over 3.3 million person-years of follow-up. Compared to metropolitan residence, small/town rural residence was associated with statistically significant but clinically negligible higher risk of HF in the entire cohort (Table 1). There was no evidence that these associations were modified by the stage of CKD (Table 1).
Conclusion
Rurality does not appear to have a clear impact on incidence of heart failure in veterans with CKD. Further studies are needed to examine whether death as a competing risk might explain this finding as rural veterans with advanced CKD and HF might be at higher risk of death.
Table 1
| RUCA Category | CKD3a | CKD3b | CKD4 | Entire cohort |
| Metropolitan | 1.00 | 1.00 | 1.00 | 1.00 |
| Micropolitan | 0.99 (0.97-1.02) | 0.99 (0.96-1.02) | 0.97 (0.91-1.04) | 0.99 (0.97-1.01) |
| Small Town/Rural | 1.02 (1.00-1.04) | 1.04 (1.00-1.07)* | 0.97 (0.91-1.04) | 1.02 (1.00-1.04) |
Hazard ratios with confidence intervals for incidence of HF in CKD patients stratified by RUCA category, with metropolitan category as a reference. Asterisk indicates hazard ratio is significant at p < 0.05.
Funding
- NIDDK Support