NDT Advance Access published online on January 28, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn775
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Exploratory study of relationship between hospitalized heart failure and chronic renal replacement therapy
1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 2 Cardiovascular Special Studies Center, United States Renal Data System (USRDS), Minneapolis, MN 3 Division of Biostatistics 4 Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA
Correspondence and offprint requests to: Kelly V. Liang, A915 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Tel: +1-412-647-7157; Fax: +1-412-647-6222; E-mail: liangk{at}upmc.edu
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Abstract |
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Background. Chronic kidney disease (CKD) is common in heart failure (HF) and is associated with poor outcomes. Renal replacement therapy (RRT) may be deferred over concerns regarding tolerability and outcomes in HF. Our objectives were to ascertain the incidence of RRT, changes in RRT incidence over time and the association between RRT and survival in hospitalized HF patients.
Methods. A retrospective cohort study of consecutive hospitalized HF patients was performed at a single centre from 1987 to 2002 with RRT data from the United States Renal Data System.
Results. Of 6276 HF patients without RRT on admission, 304 commenced chronic (
3 months) RRT (280 dialysis only; 24 transplant) at a median of 475 days after dismissal. Overall incidence was 1.6% per year. Risk-adjusted incidence increased over time and was similar in those with preserved or reduced (<50%) ejection fraction. RRT patients were younger but had worse renal function and anaemia, and more diabetes, hypertension and coronary disease. Unadjusted survival was worse in the RRT group. However, risk-adjusted survival was similar in RRT and non-RRT groups (HR = 1.11, 95% CI 0.94–1.29, P > 0.05).
Conclusions. Our data show that although RRT is increasingly used in HF patients, the impact on risk-adjusted mortality remains to be established. Further studies should focus on defining the appropriate clinical settings in which RRT should be used in HF, the timing and type of RRT and whether RRT can improve specific outcomes.
Keywords: cardiorenal failure; end-stage renal disease; heart failure; renal replacement therapy; survival
* Present address: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA.
** Present address: Division of Cardiology, University of Utah, Salt Lake City, UT, USA.
Received for publication: 29. 9.08
Accepted in revised form: 24.12.08
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