The Outcomes of Chronic Kidney Disease and Heart Failure with Reduced Ejection Fraction

Abstract

IntroductionKidney disease and heart failure (HF) make a challenging duo. By sharing a neurohormonal interplay, these diseases are rarely seen in isolation. However, many of the pivotal HF trials excluded advanced kidney disease. This, combined with an apprehension to avoid some guideline-directed medical therapy (GDMT) for HF in chronic kidney disease (CKD), make cardiorenal management unclear and puzzling.MethodsA retrospective cohort study of 1,041 patients admitted from 2005-2014 with acute HF with reduced ejection fraction (HFrEF). Patients were divided into CKD and non-CKD groups. CKD included patients with stage III to ESRD. Non-CKD included normal function to stage II. We applied the primary outcomes of interest at 1 and 6 months, the length of hospital stay, readmission rates (RAR), and overall mortality.ResultsOut of the 1,041 HFrEF patients, 140 had CKD and 901 had non-CKD. Amongst the two groups, there was a difference in the medications. CKD patients were less likely to receive angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and digitalis, and more likely to receive torsemide than their counterparts. With readmissions, the CKD group had a higher 30-day RAR, with no difference in 6-month RAR or 1-yr RAR. Overall, there was no mortality difference between the two groups, in-hospital or mortality up to 180 days.ConclusionHFrEF patients with CKD are prescribed less GDMT for HF than non-CKD patients. There are consequences of this discrepancy and room for improvement to reduce HF RAR and improve quality of life. Kidney disease and heart failure (HF) make a challenging duo. By sharing a neurohormonal interplay, these diseases are rarely seen in isolation. However, many of the pivotal HF trials excluded advanced kidney disease. This, combined with an apprehension to avoid some guideline-directed medical therapy (GDMT) for HF in chronic kidney disease (CKD), make cardiorenal management unclear and puzzling. A retrospective cohort study of 1,041 patients admitted from 2005-2014 with acute HF with reduced ejection fraction (HFrEF). Patients were divided into CKD and non-CKD groups. CKD included patients with stage III to ESRD. Non-CKD included normal function to stage II. We applied the primary outcomes of interest at 1 and 6 months, the length of hospital stay, readmission rates (RAR), and overall mortality. Out of the 1,041 HFrEF patients, 140 had CKD and 901 had non-CKD. Amongst the two groups, there was a difference in the medications. CKD patients were less likely to receive angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and digitalis, and more likely to receive torsemide than their counterparts. With readmissions, the CKD group had a higher 30-day RAR, with no difference in 6-month RAR or 1-yr RAR. Overall, there was no mortality difference between the two groups, in-hospital or mortality up to 180 days. HFrEF patients with CKD are prescribed less GDMT for HF than non-CKD patients. There are consequences of this discrepancy and room for improvement to reduce HF RAR and improve quality of life.