HEART failure, one of the primary manifestations of cardiovascular disease, has a bidirectional interaction with chronic kidney disease (CKD), termed ‘cardiorenal syndrome’.’ Up to 40% of patients with CKD who start dialysis have heart failure.
A novel retrospective cohort study revealed that heart failure with preserved ejection fraction (HFpEF) had high prevalence among patients with CKD, and the presence of heart failure correlated with 1-year all-cause and cardiovascular-related mortality among this population. Albert Yu, Permanente Los Angeles Medical Center, California, USA, and colleagues stated: “A better understanding of the epidemiology of patients with cardiorenal syndrome may improve ways to provide targeted management strategies to this vulnerable population.”
Yu and colleagues examined data of 76,688 patients with incident CKD between 2007–2017, including patients with and without heart failure. They compared patient characteristics among those with CKD without heart failure and those with it, then categorised them as HFpEF or heart failure with reduced ejection fraction (HFrEF). With heart failure alone, HFpEF or HFrEF serving as the exposures, the primary outcome was the all-cause and cardiovascular-related mortality within 1 year of identifying CKD. The researchers utilised the Cox proportional hazards model to determine the hazard ratios for risk of all-cause mortality. Likewise, the Fine–Gray sub-distribution hazard model was used to measure the risk of cardiovascular-related mortality within 1 year.
Out of the patient population, 18.6% had prevalent heart failure, of which 59.2% had HFpEF and 23.3% had HFrEF. Compared with those without heart failure, the hazard ratio for 1-year all-cause mortality among patients with heart failure was 1.70. Additionally, the hazard ratios for patients with HFpEF and HRrEF were 1.59 and 2.43, respectively. Among patients with heart failure, the hazard ratio for 1-year cardiovascular-related mortality was 6.69, compared with patients without heart failure. The cardiovascular-related mortality was higher (11.47) among patients with HFrEF.
Acknowledging the advancements in therapies for heart failure, such as neprilysin inhibitors, sodium-glucose co-transporter-2 inhibitors, and newer generation mineralocorticoid receptor antagonists, the researchers proposed that studies are required to assess the efficacy of these drugs in real world populations. Ye and colleagues stated: “We hope that hope that such future work will provide more insights into the evolving care for heart failure and CKD, ultimately to help better understand and manage this vulnerable population.”
