Heart Failure Risk Outweighs Stroke in CKD Patients

Chronic kidney disease (CKD) patients are at a risk of heart failure (HF) that is as high as for coronary heart disease (CHD), whereas stroke risk is only slightly elevated, according to a new study.

Researchers at the University of Washington (UW; Seattle, USA), Tufts Medical Center (Boston, MA, USA), and other institutions conducted a study to determine absolute rates and comparative risk differences of incident HF, CHD, and stroke in CKD patients. In all, 14,462 participants were pooled from three studies: the Jackson Heart Study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis. Main outcome and measures were incidence rates (IRs) and risk differences comparing participants with and without CKD.

The results revealed that CKD patients had a 2.3 per 1,000 person-year greater risk than those without CKD for both HF and CHD. For stroke, the risk difference was 0.8 per 1,000 per person-year in CKD, versus no CKD. Risks were particularly high for African American and Hispanic participants, with adjusted risk differences in those with CKD for HF of 3.5 and 7.8 per 1,000 person-years, respectively. The study was published on December 21, 2016, in JAMA Cardiology.

“Cardiovascular disease is the leading cause of morbidity and mortality in patients with CKD. Understanding the relative contributions of cardiovascular disease event types to the excess burden of cardiovascular disease is important for developing effective strategies to improve outcomes,” concluded lead author Nisha Bansal, MD, MAS, of the UW Kidney Research Institute, and colleagues. “The excess risk of HF associated with CKD was particularly large among African American and Hispanic individuals. Efforts to improve health outcomes for patients with CKD should prioritize HF in addition to CHD prevention.”

CKD is the progressive loss of kidney function over a period of months or years, identified by the presence of creatinine, a breakdown product of muscle metabolism. Higher levels of creatinine indicate a lower glomerular filtration rate (GFR), resulting in a decreased capability of the kidneys to excrete waste products. Symptoms are not specific, and might include feeling generally unwell or a reduced appetite. Professional guidelines classify severity of CKD in five stages, culminating in end- end-stage renal disease (ESRD), a severe illness with poor life expectancy if left untreated.

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University of Washington
Tufts Medical Center