Chronic kidney disease begets heart failure and vice versa; temporal associations between heart failure events in relation to incident chronic kidney disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Diabetes, chronic kidney disease (CKD) and heart failure (HF) are fast-growing causes of morbidity and mortality worldwide. Diabetes is an optimal model to study the inter-play of cardiovascular disease and renal disease. Purpose To investigate the association of CKD with HF and its prognosis in a large, population-based cohort of diabetes, in which incident CKD and HF events were ascertained longitudinally. Methods A population-based cohort of patients aged ≥18 years with diabetes, but without CKD, HF or acute kidney injury at baseline was identified from the previously validated territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up through December 31,2020 for incident CKD and/or HF or all-cause mortality. Multi-state modelling was used to examine the association of the subgroups (with/without CKD or HF). Results Among 294,413 patients (mean age: 65 ± 14 years; 49.5% women), new-onset CKD occurred in 51,583, in whom one-fifth (21.3%) had HF. In contrast, among 28,335 patients with new-onset HF, nearly two-fifth (38.7%) had CKD (Figure 1A). Median duration from baseline to incident CKD was shorter than incident HF [8.27 (4.69-11.97) years vs. 8.76 (5.28-12.37) years, p <0.001]. However, median duration for incident event of HF after CKD diagnosis was 2.15 (0.83-4.50) years and 1.73 (0.62-3.87) years for incident CKD after HF diagnosis. The incidence rate of CKD and HF was 20.39 per 1000 person-years and 10.61 per 1000 person-years, respectively. Presence of CKD was associated with incident HF (odds ratios [OR] 1.27 [95%CI 1.21-1.33]), and HF with incident CKD (OR 1.26 [95%CI 1.18-1.33]). The presence of both CKD and HF (regardless of which comes first) portends higher risk (6 to 8-fold hazards) of all-cause mortality than neither condition (Figure 1B). Conclusions Incident HF occurs in one-fifth of patients with new-onset CKD, and CKD occurs in about 40% with new-onset HF. CKD seems to precede HF. More research on the inter-play of these dual conditions is warranted in view of the high mortality risk. Abstract Figure.