Exploratory study of relationship between hospitalized heart failure patients and chronic renal replacement therapy

Kelly V. Liang, Eddie L. Greene, Amy W. Williams, Charles A. Herzog, David O. Hodge, Theophilus E. Owan, Margaret May Redfield

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background. Chronic kidney disease (CKD) is common in heart failure (HF) and is associated with poor outcomes. Renal replacement therapy (RRT) may be deferred over concerns regarding tolerability and outcomes in HF. Our objectives were to ascertain the incidence of RRT, changes in RRT incidence over time and the association between RRT and survival in hospitalized HF patients.Methods. A retrospective cohort study of consecutive hospitalized HF patients was performed at a single centre from 1987 to 2002 with RRT data from the United States Renal Data System.Results. Of 6276 HF patients without RRT on admission, 304 commenced chronic (≥3 months) RRT (280 dialysis only; 24 transplant) at a median of 475 days after dismissal. Overall incidence was 1.6 per year. Risk-adjusted incidence increased over time and was similar in those with preserved or reduced (<50) ejection fraction. RRT patients were younger but had worse renal function and anaemia, and more diabetes, hypertension and coronary disease. Unadjusted survival was worse in the RRT group. However, risk-adjusted survival was similar in RRT and non-RRT groups (HR = 1.11, 95 CI 0.94-1.29, P > 0.05).Conclusions. Our data show that although RRT is increasingly used in HF patients, the impact on risk-adjusted mortality remains to be established. Further studies should focus on defining the appropriate clinical settings in which RRT should be used in HF, the timing and type of RRT and whether RRT can improve specific outcomes.

Original languageEnglish (US)
Pages (from-to)2518-2523
Number of pages6
JournalNephrology Dialysis Transplantation
Volume24
Issue number8
DOIs
StatePublished - Aug 2009

Fingerprint

Renal Replacement Therapy
Heart Failure
Incidence
Chronic Renal Insufficiency
Information Systems
Dialysis
Cohort Studies
Retrospective Studies
Transplants
Kidney

Keywords

  • Cardiorenal failure
  • End-stage renal disease
  • Heart failure
  • Renal replacement therapy
  • Survival

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Exploratory study of relationship between hospitalized heart failure patients and chronic renal replacement therapy. / Liang, Kelly V.; Greene, Eddie L.; Williams, Amy W.; Herzog, Charles A.; Hodge, David O.; Owan, Theophilus E.; Redfield, Margaret May.

In: Nephrology Dialysis Transplantation, Vol. 24, No. 8, 08.2009, p. 2518-2523.

Research output: Contribution to journalArticle

Liang, Kelly V. ; Greene, Eddie L. ; Williams, Amy W. ; Herzog, Charles A. ; Hodge, David O. ; Owan, Theophilus E. ; Redfield, Margaret May. / Exploratory study of relationship between hospitalized heart failure patients and chronic renal replacement therapy. In: Nephrology Dialysis Transplantation. 2009 ; Vol. 24, No. 8. pp. 2518-2523.
@article{6d716081b9f34304b2235ea3768bfe12,
title = "Exploratory study of relationship between hospitalized heart failure patients and chronic renal replacement therapy",
abstract = "Background. Chronic kidney disease (CKD) is common in heart failure (HF) and is associated with poor outcomes. Renal replacement therapy (RRT) may be deferred over concerns regarding tolerability and outcomes in HF. Our objectives were to ascertain the incidence of RRT, changes in RRT incidence over time and the association between RRT and survival in hospitalized HF patients.Methods. A retrospective cohort study of consecutive hospitalized HF patients was performed at a single centre from 1987 to 2002 with RRT data from the United States Renal Data System.Results. Of 6276 HF patients without RRT on admission, 304 commenced chronic (≥3 months) RRT (280 dialysis only; 24 transplant) at a median of 475 days after dismissal. Overall incidence was 1.6 per year. Risk-adjusted incidence increased over time and was similar in those with preserved or reduced (<50) ejection fraction. RRT patients were younger but had worse renal function and anaemia, and more diabetes, hypertension and coronary disease. Unadjusted survival was worse in the RRT group. However, risk-adjusted survival was similar in RRT and non-RRT groups (HR = 1.11, 95 CI 0.94-1.29, P > 0.05).Conclusions. Our data show that although RRT is increasingly used in HF patients, the impact on risk-adjusted mortality remains to be established. Further studies should focus on defining the appropriate clinical settings in which RRT should be used in HF, the timing and type of RRT and whether RRT can improve specific outcomes.",
keywords = "Cardiorenal failure, End-stage renal disease, Heart failure, Renal replacement therapy, Survival",
author = "Liang, {Kelly V.} and Greene, {Eddie L.} and Williams, {Amy W.} and Herzog, {Charles A.} and Hodge, {David O.} and Owan, {Theophilus E.} and Redfield, {Margaret May}",
year = "2009",
month = "8",
doi = "10.1093/ndt/gfn775",
language = "English (US)",
volume = "24",
pages = "2518--2523",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Exploratory study of relationship between hospitalized heart failure patients and chronic renal replacement therapy

AU - Liang, Kelly V.

AU - Greene, Eddie L.

AU - Williams, Amy W.

AU - Herzog, Charles A.

AU - Hodge, David O.

AU - Owan, Theophilus E.

AU - Redfield, Margaret May

PY - 2009/8

Y1 - 2009/8

N2 - Background. Chronic kidney disease (CKD) is common in heart failure (HF) and is associated with poor outcomes. Renal replacement therapy (RRT) may be deferred over concerns regarding tolerability and outcomes in HF. Our objectives were to ascertain the incidence of RRT, changes in RRT incidence over time and the association between RRT and survival in hospitalized HF patients.Methods. A retrospective cohort study of consecutive hospitalized HF patients was performed at a single centre from 1987 to 2002 with RRT data from the United States Renal Data System.Results. Of 6276 HF patients without RRT on admission, 304 commenced chronic (≥3 months) RRT (280 dialysis only; 24 transplant) at a median of 475 days after dismissal. Overall incidence was 1.6 per year. Risk-adjusted incidence increased over time and was similar in those with preserved or reduced (<50) ejection fraction. RRT patients were younger but had worse renal function and anaemia, and more diabetes, hypertension and coronary disease. Unadjusted survival was worse in the RRT group. However, risk-adjusted survival was similar in RRT and non-RRT groups (HR = 1.11, 95 CI 0.94-1.29, P > 0.05).Conclusions. Our data show that although RRT is increasingly used in HF patients, the impact on risk-adjusted mortality remains to be established. Further studies should focus on defining the appropriate clinical settings in which RRT should be used in HF, the timing and type of RRT and whether RRT can improve specific outcomes.

AB - Background. Chronic kidney disease (CKD) is common in heart failure (HF) and is associated with poor outcomes. Renal replacement therapy (RRT) may be deferred over concerns regarding tolerability and outcomes in HF. Our objectives were to ascertain the incidence of RRT, changes in RRT incidence over time and the association between RRT and survival in hospitalized HF patients.Methods. A retrospective cohort study of consecutive hospitalized HF patients was performed at a single centre from 1987 to 2002 with RRT data from the United States Renal Data System.Results. Of 6276 HF patients without RRT on admission, 304 commenced chronic (≥3 months) RRT (280 dialysis only; 24 transplant) at a median of 475 days after dismissal. Overall incidence was 1.6 per year. Risk-adjusted incidence increased over time and was similar in those with preserved or reduced (<50) ejection fraction. RRT patients were younger but had worse renal function and anaemia, and more diabetes, hypertension and coronary disease. Unadjusted survival was worse in the RRT group. However, risk-adjusted survival was similar in RRT and non-RRT groups (HR = 1.11, 95 CI 0.94-1.29, P > 0.05).Conclusions. Our data show that although RRT is increasingly used in HF patients, the impact on risk-adjusted mortality remains to be established. Further studies should focus on defining the appropriate clinical settings in which RRT should be used in HF, the timing and type of RRT and whether RRT can improve specific outcomes.

KW - Cardiorenal failure

KW - End-stage renal disease

KW - Heart failure

KW - Renal replacement therapy

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=67651136878&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651136878&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfn775

DO - 10.1093/ndt/gfn775

M3 - Article

C2 - 19176683

AN - SCOPUS:67651136878

VL - 24

SP - 2518

EP - 2523

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 8

ER -