#2033 Patient characteristics and outcomes of an inter- and multidisciplinary nephrology and cardiology clinic

Abstract

Abstract Background and Aims The prevalence of cardiorenal syndrome is increasing due to the growing number of patients with chronic kidney disease (CKD) and heart failure (HF). To further improve outcomes in this high risk population, an interdisciplinary, evidence-based and patient-centered approach is advocated. Hence, it was the aim of this study to identify and describe the patient population which might profit from an inter- and multidisciplinary nephrology and cardiology clinic at a tertiary university hospital. Method We screened 552 patients who from 01.01.2015 and 30.06.2022 had been in the nephrology and in the cardiology outpatient clinics of the University Hospital of Zurich. Patients with kidney or heart transplantation or on dialysis were excluded. Out of the remaining patients, we identified 223 patients having CKD 2-5 and HF. Characteristics with respect to entity and cause of kidney and heart disease, cardiovascular risk factors, therapy, incidence of acute kidney injury (AKI), hospitalisations and patient survival were recorded. Results The most common cause of CKD was a cardiorenal syndrome type 2 (42%, 95/223). 59/223 (26%) had at least moderate albuminuria. At the beginning of follow-up, 61/223 (26%) were in CKD2, 95/223 (42%) in CKD3a, 47/223 (21%) in CKD3b, 6/223 (7%) in CKD4 1, 2/223 (1%) in CKD5. Ischemic cardiomyopathy was the most common cause of heart failure, (36%, 80/223 patients). 119/223 patients (53%) had HFrEF, 41/223 (19%) HFmrEF and 63/223 (28%) HFpE. 64/223 (28%) of the patients were treated with SGLT2i,159/223 (71%) with RASi of which 37 (17%) were on an ARNI. Patients under combined RASi and SGLT2i were younger (66 vs 73 years, p = 0.005), were more likely to have diabetes (44% vs 30%), HFrEF rather than HFpEF (70% vs 7% p = 0.002) and had a better kidney function at the beginning of follow-up (eGFR 65 vs 55 ml/min/1.73 m2, p < 0.001). Hospitalization-rate due to HF and incidence of AKI were high with 0.6/patient/year and 4.8/patient/year respectively. 72/223 (32%) patients died during the mean follow-up of 3.1 years. Conclusion We identified a high-risk patient population with cardiorenal disease that might particularly benefit from evidence-based and patient-centered interdisciplinary care. A cardiorenal outpatient clinic may have the potential to improve a personalized approach in more vulnerable patients.