Risk of adverse kidney outcomes in older patients hospitalized for HF
In a nationwide retrospective cohort study among US patients aged ≥65 years, a lower eGFR at discharge was associated with a higher risk of adverse kidney and clinical outcomes 1 year after HF hospitalization.
This summary is based on the publication of Ostrominski JW, Greene SJ, Patel RB, et al. - Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure. JAMA Cardiol. 2024 Jul 1;9(7):667-672. doi: 10.1001/jamacardio.2024.1108
Introduction and methods
Background
Kidney health has received renewed attention as part of HF prevention and treatment efforts, including in major HF trials [1]. However, knowledge of the occurrence of clinically relevant kidney outcomes in contemporary HF populations, especially older patients, are lacking.
Aim of the study
The authors examined the rates of incident dialysis and acute kidney injury (AKI) after HF hospitalization in older US adults.
Methods
In a retrospective cohort study, data were collected from the Get With The Guidelines-Heart Failure registry for 85,298 Medicare beneficiaries (aged ≥65 years) who were hospitalized for HF across 372 sites in the US in the period 2014–2018. Patients requiring dialysis prior to or during hospitalization were excluded. Of the study population, 54,010 (63%) had eGFR <60 mL/min per 1.73 m² at discharge.
Outcomes
The primary endpoint was postdischarge initiation of inpatient dialysis at 1 year. Secondary endpoints included other kidney events (readmission for dialysis or end-stage kidney disease (ESKD) and readmission for AKI) and other clinical outcomes (all-cause mortality, all-cause readmission, and HF readmission).
Main results
- At 1 year after HF hospitalization, 6% of the patients had progressed to dialysis, 7% had progressed to dialysis or ESKD, and 7% had been readmitted for AKI. In addition, 34% had died of any cause, 65% had been readmitted for any cause, and 30% had been readmitted for HF.
- Compared with patients with eGFR ≥60 mL/min per 1.73 m² at discharge, patients with eGFR 45–59 mL/min per 1.73 m² (adjusted HR (AHR): 2.16; 95%CI: 1.86–2.51; P<0.001) and those with eGFR <30 mL/min per 1.73 m² (28.46; 95%CI: 25.25–32.08; P<0.001) showed an increased incidence of inpatient dialysis.
- Similar findings were found for incident readmission for dialysis or ESKD, readmission for AKI, and other clinical outcomes.
- When eGFR was analyzed as a continuous variable, a lower discharge eGFR (per decrease of 10 mL/min per 1.73 m²) was independently associated with an increased rate of readmission for dialysis (AHR: 2.23; 95%CI: 2.14–2.32; P<0.001), readmission for dialysis or ESKD (AHR: 2.34; 95%CI: 2.24–2.44; P<0.001), and readmission for AKI (AHR: 1.25; 95%CI: 1.23–1.27; P<0.001).
- Once more, similar results were seen for the other clinical outcomes. • Cox proportional hazards regression analysis showed baseline LVEF did not change the covariate-adjusted association between lower discharge eGFR and kidney outcomes.
Conclusion
In this nationwide retrospective cohort study, 63% of the older US patients hospitalized for HF had eGFR <60 mL/min per 1.73 m² at discharge. In the year following admission, 6% of the study participants had progressed to dialysis. A lower discharge eGFR was associated with a higher risk of adverse kidney and clinical outcomes at 1 year. The authors believe “these findings highlight the importance of prioritizing kidney health as part of comprehensive approaches to HF care.”
Reference
1. Khan MS, Bakris GL, Packer M, et al. Kidney function assessment and endpoint ascertainment in clinical trials. Eur Heart J. 2022;43(14):1379-1400. doi:10.1093/eurheartj/ehab832