Clinical outcomes and death associated with cardiorenal syndromes. A comprehensive nationwide cohort study

Abstract

Abstract Background Cardiorenal syndromes (CRS) are associated with increased risks of all-cause and cardiovascular death, end-stage kidney disease (ESKD), myocardial infarction (MI), heart failure (HF) and ischemic stroke. Whether subtypes of CRS are more prone to develop specific complications is unclear. Methods This longitudinal cohort study was based on the national hospitalisation database covering hospital care from the entire French population. The analysis focused on those with at least 5 years of complete follow-up (or dead earlier) as described by others. We identified 385,687 consecutive patients hospitalized in France in 2012 who had heart failure (HF), chronic kidney disease (CKD) and/or CRS. We estimated incidence of cardiovascular and all-cause death, MI, hospitalization for HF, ischemic stroke, ESKD (chronic dialysis or transplantation). Analysis were adjusted for 1) age and sex and 2) all baseline characteristics except cardiac and renal comorbidities. Results Overall, 57.7% were male, 67.3% had hypertension, 31.1% had diabetes mellitus and their mean age was 75.3±13.2; 34,217 had isolated CKD, 324,141 had HF, 11,162 had acute concomitant CRS (which could be type 1, 3 or 5 CRS), 12,198 had type 2 CRS and 3,969 had type 4 CRS. Type 2 CRS was associated with the highest 5-year incidence of all-cause (30.3/100 patient-years [29.7–30.9]) and cardiovascular (10.7 [10.4–11.1]) death and HF (46.9 [45.9–47.9]), type 4 CRS with the highest incidence of MI (2.50 [2.21–2.83]) and patients with acute CRS with the highest incidence of ischemic stroke (2.05 [1.89–2.21]). The incidence of ESKD was 7.43/100 patient-years [6.92–7.99] for type 4 and 6.31 [6.03–6.61] for type 2 CRS, 6.16 [5.88–6.45] for aCRS, 6.00 [5.87–6.14] for CKD and 1.17 [1.15–1.19] for HF. As compared to CKD, the adjusted risk of ESKD was higher in type 4 (HR: 1.18 [1.10–1.28]) and aCRS (1.07 [1.02–1.13]) and similar for type 2 (HR: 0.99 [0.94–1.04]) CRS. The adjusted risk of all-cause and cardiovascular death and HF was higher in patients with type 2 CRS vs all other groups, and higher in aCRS and 4 CRS than isolated CKD. Conclusion The long-term prognosis of CRS subtypes is poor but varies widely, some CRS subtypes being more closely associated with specific complications than others. Funding Acknowledgement Type of funding sources: None. All-cause deathCardiovascular death