title: Kansas City Cardiomyopathy Questionnaire Score Is Associated With Incident Heart Failure Hospitalization in Patients With Chronic Kidney Disease Without Previously Diagnosed Heart Failure: Chronic Renal Insufficiency Cohort Study.
abstract: BACKGROUND
  Chronic kidney disease is a risk factor for heart failure (HF). Patients with chronic kidney disease without diagnosed HF have an increased burden of symptoms characteristic of HF. It is not known whether these symptoms are associated with occurrence of new onset HF.
  
  
  RESULTS
  We studied the association of a modified Kansas City Cardiomyopathy Questionnaire with newly identified cases of hospitalized HF among 3093 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not report HF at baseline. The annually updated Kansas City Cardiomyopathy Questionnaire score was categorized into quartiles (Q1-4) with the lower scores representing the worse symptoms. Multivariable-adjusted repeated measure logistic regression models were adjusted for demographic characteristics, clinical risk factors for HF, N-terminal probrain natriuretic peptide level and left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction. Over a mean (±SD) follow-up period of 4.3±1.6 years, there were 211 new cases of HF hospitalizations. The risk of HF hospitalization increased with increasing symptom quartiles; 2.62, 1.85, 1.14, and 0.74 events per 100 person-years, respectively. The median number of annual Kansas City Cardiomyopathy Questionnaire assessments per participant was 5 (interquartile range, 3-6). The annually updated Kansas City Cardiomyopathy Questionnaire score was independently associated with higher risk of incident HF hospitalization in multivariable-adjusted models (odds ratio, 3.30 [1.66-6.52]; P=0.001 for Q1 compared with Q4).
  
  
  CONCLUSIONS
  Symptoms characteristic of HF are common in patients with chronic kidney disease and are associated with higher short-term risk for new hospitalization for HF, independent of level of kidney function, and other known HF risk factors.
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Mishra
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Christopher
authors.initials: C
authors.lastname: DeFilippi
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Patrice
authors.initials: P
authors.lastname: Delafontaine
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Radhakrishna
authors.initials: R
authors.lastname: Kallem
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Lora
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.). michael.shlipak@ucsf.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: heart failure; hospitalization; renal insufficiency, chronic