Potential link seen between heart failure post-hospitalization, kidney disease
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Key takeaways:
- In this study, a lower discharge eGFR was independently associated with a higher rate of readmission for AKI.
- More than one in 20 patients progressed to dialysis within 1 year after hospitalization.
In a study of Medicare beneficiaries, researchers from Brigham and Women’s Hospital found that 6% of patients treated for heart failure progressed to dialysis within 1 year after hospitalization.
“We know that heart and kidney health are highly interconnected, but management of heart and kidney disease remains relatively siloed, and kidney health often isn’t prioritized in patients with heart disease until advanced stages,” John W. Ostrominski, MD, a fellow in cardiovascular medicine and obesity medicine at the Brigham and Women’s Hospital and lead author on the study, said in a press release. “Declining kidney function is often asymptomatic until late in the disease course, but even less advanced stages of kidney impairment can have important implications for cardiovascular health. Hence, there’s a need for analyses that assess kidney outcomes in people with heart failure.”
Ostrominski and colleagues analyzed Medicare claims data from 85,298 patients older than 65 years who were hospitalized with heart failure between Jan. 1, 2014, and Dec. 31, 2018. Patients younger than 65 years or requiring dialysis either during or prior to hospitalization were excluded. Data were sourced from the Get with the Guidelines-Heart-Failure Registry, an initiative that connects hospitals with current evidence-based guidelines and measurement tools.
By the end of the first year after hospitalization for heart failure, “6% of patients in the study had progressed to dialysis; 7% had progressed to dialysis or end-stage kidney disease, and 7% had been readmitted for AKI,” the researchers wrote in JAMA Cardiology. “Incident dialysis increased steeply with lower discharge eGFR category: compared with patients with an eGFR of 60 mL/min per 1.73 m2 or more, individuals with an eGFR of 45 [mL/min per 1.73 m2] to less than 60 [mL/min per 1.73 m2] and of less than 30 mL/min per 1.73 m2 had higher rates of dialysis readmission,” the researchers wrote. “Lower discharge eGFR (per 10 mL/min per 1.73 m2 decrease) was independently associated with a higher rate of readmission for dialysis, dialysis or end-stage kidney disease and AKI, with similar findings for all-cause mortality, all-cause readmission and HF readmission,” they wrote.
Researchers also found the risk of adverse kidney outcomes increased steeply in patients with low kidney function prior to the heart surgery.
“In this cohort study, older adults had substantial risk of kidney complications, readmission and death early after [heart failure] hospitalization,” the researchers wrote. “These findings emphasize the need for health care delivery approaches prioritizing both cardiovascular and kidney health in this high-risk population.”
In the press release, Ostrominski said, “The trends we’ve observed aren’t especially surprising given what we know about the links between heart and kidney health, but what’s important is that this research emphasizes the scope of the problem and gives us information we can act upon to directly improve clinical outcomes in patients with heart failure.
“There are important opportunities for patients and providers, health care institutions, and, at the broader state and national levels, in terms of health care policy that could make a big difference for patients,” he said.
Reference:
Study finds older adults hospitalized for heart failure had high risk of kidney complications. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=4719. Published May 28, 2024. Accessed May 29, 2024.
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