Abstract 14370: Mortality Among Patients With Heart Failure After Initiation of Hemodialysis

Abstract

Introduction: Patients with kidney failure on hemodialysis (HD) have a high risk of cardiovascular (CV) events and a high burden of heart failure (HF) morbidity and mortality. Standard HF therapies have not been proven to have similar benefits in patients with kidney failure. While comorbid HF and kidney failure requiring HD portends poor prognosis, the survival for patients with pre-existing HF who start HD and its relationship to left ventricular ejection fraction (EF) has not been well-described. Methods: We included patients with a diagnosis of HF (ICD-9/10 codes confirmed by chart review) and chronic kidney disease (CKD) seen at a tertiary care VA medical center and subsequently initiated on HD between 1/2005 and 12/2017. Echocardiographic data, including baseline and follow-up EF and baseline clinical data at time of HD initiation, and date of death or last follow-up were collected using chart review. Time to event analysis for all-cause mortality from date of HD initiation was conducted. Results: The cohort included 356 patients (mean age 66.2 ± 9.0 years, 96.6% male, 55.6% CAD, 20% CABG). HF with preserved EF (HFpEF; EF≥50%) was the most common HF subgroup (62%), followed by HF with reduced EF (HFrEF; EF≤40%) and HF with mid-range EF (HFmrEF; EF 41-49%) (23% and 15%, respectively). Mean time from HF diagnosis to HD start was 1.75 ± 1.95 years. Compared to HFrEF, HFpEF patients had shorter time to HD start (1.60 vs. 2.12 years, p=0.046). The overall survival after initiation of HD for patients with pre-existing HF was 80.9% at 1-year, 64.2% at 2-year, and 37.0% at 5-year follow-up. Median survival was longest for HFpEF (4.1 years), followed by HFmrEF (3.2 years) and HFrEF (1.6 years) ( Figure ). Conclusions: Patients with pre-existing HF and CKD who transition to HD experience significant mortality, with HFrEF patients having substantially worse survival. Further study of HF optimization prior to and after HD initiation is needed, especially in the highest risk HFrEF patients.