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Abstract: TH-PO628

Cardiorenal Syndrome and Death Risk in Heart Failure or CKD Patients: An Urgent Call for Action

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Santos Araujo, Carla Alexandra R., UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal, Porto, Portugal
  • Mendonça, Luís Carlos, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal, Porto, Portugal
  • Seabra, Daniel, Cardiology Department, Pedro Hispano Hospital, Matosinhos, Portugal, Matosinhos, Portugal
  • Bernardo, Filipa, Medical Department, AstraZeneca, Lisbon, Portugal, Lisbon, Portugal
  • Pardal, Marisa, Medical Department, AstraZeneca, Lisbon, Portugal, Lisbon, Portugal
  • Couceiro, João, Medical Department, AstraZeneca, Lisbon, Portugal, Lisbon, Portugal
  • Martinho, Hugo Miguel, Medical Department, AstraZeneca, Lisbon, Portugal, Lisbon, Portugal
  • Dias, Daniel, Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Portugal, Porto, Portugal
  • Dinis-Oliveira, Ricardo Jorge, TOXRUN – Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, Portugal, Gandra, Portugal
  • Gavina, Cristina, Cardiology Department, Pedro Hispano Hospital, Matosinhos, Portugal, Matosinhos, Portugal
  • Taveira Gomes, Tiago, Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Portugal, Porto, Portugal
Background

Simultaneous occurrence of heart failure (HF) and chronic kidney disease (CKD) is known as cardiorenal syndrome (CRS). This study aims to estimate 1-year CRS risk in HF or CKD patients and 1-year risk of all-cause death, cardiovascular (CV) death and non-fatal major CV events (MACE) in HF, CKD and CRS patients.

Methods

Retrospective analysis of integrated healthcare institution database from 2008-2019. We defined 4 cohorts: Control - 75 years old; HF - HF patients without CKD; CKD - CKD patients without HF; CRS - HF and CKD patients. HF was defined as: i) ejection fraction (EF)≤40% and NT-proBNP≥200pg/mL OR BNP≥100pg/mL; ii) EF>40% in the presence of structural cardiac abnormalities. CKD was defined as eGFR≤60mL/min (EPI-CKD). Hazard ratios and 95% confidence intervals were estimated by Cox regression models adjusted for age, sex, hypertension, myocardial infarction, stroke, peripheral artery disease and type 2 diabetes.

Results

We identified 3973 HF patients, 13990 with CKD, 6784 with CRS and 16182 controls. Patients were 75-77 years old, mostly female and well treated with CV drugs. On follow-up 1293 CKD patients (9.2%) and 593 HF patients (14.9%) developed CRS. All-cause death risk was 4.7 (4.1-5.2) for HF and 4.9 (4.5-5.4) for CKD. CV death risk was 8.6 (6.8-10.8) for HF and 8.7 (7.1-10.6) for CKD. Non-fatal MACE risk was 7.4 (6.3-8.7) for HF, 4.6 (4.0-5.3) for CKD, and 7.1 (6.1-8.3) for CRS. CRS was associated with the highest risk of all-cause and CV death: 7.1 (6.4-7.9) and 13.7 (11.7-17.0), respectively (Figure 1). Most events occurred in first 90 days.

Conclusion

Cardiorenal disease was associated with very high short-term risk of CRS or death, with highest risk in CRS patients. These results support an urgent need for improved prevention of cardiorenal disease and CRS.

Funding

  • Commercial Support