Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure

Xinju Zhao; Liangying Gan; Qingyu Niu; Fan Fan Hou; Xinling Liang; Xiaonong Chen; Yuqing Chen; Junhui Zhao; Keith McCullough; Zhaohui Ni; Li Zuo

doi:10.1159/000529802

Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure

Kidney Dis (Basel). 2023 Mar 3;9(4):306-316. doi: 10.1159/000529802. eCollection 2023 Aug.

Authors

Xinju Zhao¹, Liangying Gan¹, Qingyu Niu¹, Fan Fan Hou², Xinling Liang³, Xiaonong Chen⁴, Yuqing Chen⁵, Junhui Zhao⁶, Keith McCullough⁶, Zhaohui Ni⁷, Li Zuo¹

Affiliations

¹ Department of Nephrology, Peking University People's Hospital, Beijing, China.
² Division of Nephrology, National Clinical Research Center of Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Division of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁵ Renal Division, Peking University First Hospital, Beijing, China.
⁶ Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
⁷ Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Introduction: Congestive heart failure (CHF) is one of the common complications in patients with end-stage kidney disease. In the general population, CHF increases the risk of the death. However, there is no well-designed relevant study in the Chinese hemodialysis (HD) population addressing the risks associated with CHF. The aim of this study was to explore the impact of CHF on clinical outcomes in HD patients.

Methods: Data from a prospective cohort study, the China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5 (2012-2015), were analyzed. Demographic data, comorbidities, lab data, and death records were extracted. CHF was defined by the diagnosis records upon study inclusion. Our primary outcome was all-cause and cardiovascular (CV) mortality; secondary outcomes were all-cause and cause-specific hospitalization risk. Associations between CHF and outcomes were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were carried out.

Results: Of 1,411 patients without missing CHF history information, 24.1% (340) had CHF diagnosis at enrollment. The overall mortality rates were 21.8% versus 12.0% (p < 0.001) in patients with and without CHF during follow-up, respectively. CHF was associated with higher all-cause mortality (adjusted HR: 1.72, 95% confidence interval [CI]: 1.17-2.53, p = 0.006), and the association with CV death was of similar magnitude (HR: 1.60, 95% CI: 0.91-2.81, p = 0.105). CHF patients had more episodes of hospitalization due to heart failure (HR: 2.93, 95% CI: 1.49-5.76, p < 0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR: 1.09, 95% CI: 0.90-1.33, p = 0.39). Subgroup analysis found that the effect of CHF on all-cause mortality was stronger for male patients, patients with residual renal function, the elderly (≥60 years of age), patients with arteriovenous fistulae vascular accesses, nondiabetic patients, low-flux dialyzer users, and inadequately dialyzed patients (standardized Kt/V <2).

Conclusion: In HD patients, CHF was found to be associated with a higher risk of all-cause mortality and cause-specific hospitalization risk. Further research is needed to identify opportunities to improve care for HD patients combined with CHF.

Keywords: Cardiovascular death; Congestive heart failure; DOPPS; Hemodialysis; Mortality.

Grants and funding

The Dialysis Outcomes and Practice Patterns Study (DOPPS) Program in China is supported by Vifor Fresenius Renal Pharma, Sanofi Renal, Nipro Trading (Shanghai) Co., Ltd, 3SBio Inc., B. Braun, and CEMMA MEDICAL. None of these entities had any role in the study design, data collection, analysis, interpretation, and writing of the report. None of the support provided by these entities imposed any restriction on the publications of the results. This article was supported by Beijing Natural Science Foundation (No 7222201), and the grant recipient is Li ZUO.