title: ESRD and death after heart failure in CKD.
abstract: CKD is a risk factor for heart failure, but there is no data on the risk of ESRD and death after recurrent hospitalizations for heart failure. We sought to determine how interim heart failure hospitalizations modify the subsequent risk of ESRD or death before ESRD in patients with CKD. We retrospectively identified 2887 patients with a GFR between 15 and 60 ml/min per 1.73 m2 referred between January of 2001 and December of 2008 to a nephrology clinic in Toronto, Canada. We ascertained interim first, second, and third heart failure hospitalizations as well as ESRD and death before ESRD outcomes from administrative data. Over a median follow-up time of 3.01 (interquartile range=1.56-4.99) years, interim heart failure hospitalizations occurred in 359 (12%) patients, whereas 234 (8%) patients developed ESRD, and 499 (17%) patients died before ESRD. Compared with no heart failure hospitalizations, one, two, or three or more heart failure hospitalizations increased the adjusted hazard ratio of ESRD from 4.89 (95% confidence interval [95% CI], 3.21 to 7.44) to 10.27 (95% CI, 5.54 to 19.04) to 14.16 (95% CI, 8.07 to 24.83), respectively, and the adjusted hazard ratio death before ESRD from 3.30 (95% CI, 2.55 to 4.27) to 4.20 (95% CI, 2.82 to 6.25) to 6.87 (95% CI, 4.96 to 9.51), respectively. We conclude that recurrent interim heart failure is associated with a stepwise increase in the risk of ESRD and death before ESRD in patients with CKD.
authors.affiliation: Department of Medicine.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Sud
authors.affiliation: Division of Nephrology, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada;
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Department of Biostatistics, University Health Network, Toronto, Ontario, Canada; and Dalla Lana School of Public Health.
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.affiliation: Division of Nephrology, Tufts Medical Centre, Boston, Massachusetts.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Dalla Lana School of Public Health, Division of Nephrology, Sunnybrook Health Sciences Centre, and Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; david.naimark@sunnybrook.ca.
authors.forename: David M J
authors.initials: DM
authors.lastname: Naimark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012008:Recurrence
keywords: CKD; ESRD; clinical epidemiology; congestive heart failure; mortality risk