Adding heart failure to chronic kidney disease affects transition to dialysis
Patients with heart failure in addition to chronic kidney disease were more likely to have dialysis initiated in the hospital and to receive it by a central venous catheter than those without heart failure, a study found.
Patients with chronic kidney disease (CKD) and heart failure (HF) were more likely to start dialysis as inpatients, a study found.
To compare dialysis transition patterns of CKD patients with and without HF, researchers conducted a cross-sectional study among adults in a single health care system who began maintenance dialysis between January 2007 and December 2018. The primary outcome was inpatient first-time dialysis followed by maintenance dialysis. Secondary outcomes included estimated glomerular filtration rate (eGFR) when starting maintenance dialysis and placement of tunneled central venous catheter (CVC) as opposed to arteriovenous fistula or graft. Results were published Feb. 18 by Mayo Clinic Proceedings.
Of 6,812 patients with CKD who began dialysis, 2,498 (37%) had HF. Dialysis was started during hospitalization in 463 (18.5%) patients with HF versus 416 (9.6%) without HF. The mean eGFR at dialysis initiation was 11.3 mL/min per 1.73 m2 with HF versus 9.4 mL/min per 1.73 m2 without HF (P<0.001). Of 5,499 patients who started hemodialysis, CVCs were implanted in 1,302 (58.5%) HF patients versus 1,698 (51.9%) non-HF patients. Compared with non-HF patients, patients with HF had a higher risk of starting dialysis in the hospital and getting a CVC (multivariate risk ratios, 1.46 [95% CI, 1.26 to 1.69] and 1.04 [95% CI, 0.99 to 1.10], respectively). Patients with HF with reduced ejection fraction had an even higher likelihood of CVC placement (risk ratio, 1.23 [95% CI, 1.14 to 1.33]).
Researchers noted key limitations to the study, including lack of information about the time between CKD incidence and starting maintenance dialysis.
“These findings highlight the clinically distinct nature of patients with CKD and HF, underscoring the need to further evaluate dialysis transition management strategies in this population of at-risk patients that may be different from CKD patients without HF,” the authors wrote.