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Abstract: TH-PO627

Cardiorenal Syndrome and Kidney Disease Progression in Patients With Heart Failure or CKD: Is the Heart Leading the Way?

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

Simultaneous occurrence of heart failure (HF) and chronic kidney disease (CKD) is known as cardiorenal syndrome (CRS). This study aims to assess CKD progression and estimate 1-year risk of end-stage renal disease (ESRD) in patients with HF, CKD and CRS.

Methods

Retrospective analysis of an integrated healthcare institution database from 2008-2019 was performed. We defined 4 incident cohorts: Control - 75 years old; HF - HF patients without CKD; CKD - CKD patients without HF; CRS - patients with HF and CKD. HF was defined as either: 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). Kidney disease progression was evaluated by eGFR drop of ≥50% from baseline and ESRD defined by eGFR <15mL/min or any ICD-9/10 codes for dialysis. Hazard ratios and 95% confidence intervals were estimated using Cox regression models adjusted for age, sex, hypertension, myocardial infarction, stroke, peripheral artery disease and type 2 diabetes.

Results

We identified 3973 patients with HF, 13990 with CKD, 6784 with CRS and 16182 controls. Patients were 75-77 years old, mostly female and well treated with CV drugs. eGFR drop ≥50% form baseline was observed early at 60 days (7% in CKD, 9% in HF and 13% in CRS) and maintained throughout the observation period. ESRD risk was 4.0 in HF patients (3.1-5.3) and 4.1 in CKD patients (3.3-5.1). CRS was associated with the highest risk of ESRD development: 9.9 (7.9-12.4) (Figure 1).

Conclusion

Kidney disease progression was frequent in cardiorenal disease patients and occurred early in disease development. CRS establishment added a significant risk of early and fast ESRD. Although HF patients begin with higher eGFR, overall ESRD risk is similar which deserves future analysis.

Funding

  • Commercial Support –