Risk of end-stage renal disease in patients with hypertrophic cardiomyopathy: A nationwide population-based cohort study

Heesun Lee,Hyung-Kwan Kim,Steve R Ommen,Goo-Yeong Cho,Kyungdo Han,Yong-Jin Kim,Yeonyee E Yoon,Su-Yeon Choi,Jun-Bean Park,Hyo Eun Park,In-Chang Hwang

doi:10.1038/s41598-019-50993-5

Abstract

Although hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, has mortality rate as low as general population, previous studies have focused on identifying high-risk of sudden cardiac death. Thus, long-term systemic impact of HCM is still unclear. We sought to investigate the association between HCM and end-stage renal disease (ESRD). This was a nationwide population-based cohort study using the National Health Insurance Service database. We investigated incident ESRD during follow-up in 10,300 adult patients with HCM (age 62.1 years, male 67.3%) and 51,500 age-, sex-matched controls. During follow-up (median 2.8 years), ESRD developed in 197 subjects; 111 (1.08%) in the HCM, and 86 (0.17%) in the non-HCM (incidence rate 4.14 vs. 0.60 per 1,000 person-years, p < 0.001). In the HCM, the incidence rate for ESRD gradually increased with age, but an initial peak and subsequent plateau in age-specific risk were observed. HCM was a significant predictor for ESRD (unadjusted HR 6.90, 95% CI 5.21–9.15, p < 0.001), as comparable to hypertension and diabetes mellitus. Furthermore, after adjusting for all variables showing the association in univariate analysis, HCM itself remained a robust predictor of ESRD development (adjusted HR 3.93, 95% CI 2.82–5.46, p < 0.001). The consistent associations between HCM and ESRD were shown in almost all subgroups other than smokers and subjects with a history of stroke. Conclusively, HCM increased the risk of ESRD, regardless of known prognosticators. It provides new insight into worsening renal function in HCM, and active surveillance for renal function should be considered.

Highlights

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, with a prevalence of approximately 1:500 in the general population[1,2]
end-stage renal disease (ESRD) developed more frequently in the hypertrophic cardiomyopathy (HCM) than in the non-HCM group (1.08% vs. 0.17%, p < 0.001), even though the follow-up duration was longer in the non-HCM group (2.6 vs. 2.8 years, p < 0.001)
Kaplan-Meier curve demonstrated that HCM patients had a higher incidence probability of ESRD than non-HCM subjects (Fig. 1A)

Summary

Introduction

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, with a prevalence of approximately 1:500 in the general population[1,2]. Clinical interests have focused on identifying patients at higher risk and preventing unfavorable outcomes, sudden death[3,4,5]. These allow clinicians to understand the disease better and extend survival[1]. Under the current comprehensive management, the majority of HCM patients remain symptom-free throughout their lives, with an annual mortality rate of approximately 1%, as low as general population[5]. Chronic kidney disease is a strong risk factor for cardiovascular morbidity and mortality, aggravating outcomes proportional to renal dysfunction[6,7]. Among patients with end-stage renal disease (ESRD), approximately 50% of the deaths are caused by cardiovascular disease[8]. We sought to investigate the incidence and risk of ESRD development in patients with HCM via a large-scale nationwide cohort study

Methods

Results

Conclusion