Heart Failure, Other CVD Increase Risk for ESRD

A new analysis reports that major cardiovascular diseases (CVD) are significantly and independently associated with the risk of end-state renal disease (ESRD).

Heart failure, atrial fibrillation, coronary heart disease, and stroke were each linked with a higher risk of developing kidney failure with heart failure associated with the highest risk.

Cardiorenal syndrome is a well-recognized clinical entity with extensive evidence of chronic kidney disease (CKD) as a risk factor for CVD. Citing a dearth of research on the reciprocal relationship, ie, the impact of CVD on long-term risk of ESRD, a team led by Kunihiro Matsushita, MD, PhD and Junichi Ishigami, MD, PhD of the Johns Hopkins Bloomberg School of Public Health, assessed the association of incident CVD with risk of ESRD in 9047 participants of the prospective Atherosclerosis Risk in Communities Study.

Results were published in the Journal of the American Society of Nephrology.

"Many physicians probably recognize that patients with cardiovascular disease are at risk of kidney disease progression, but to my knowledge, this is the first study quantifying the contribution of different cardiovascular diseases to the development of kidney failure," said Dr. Matsushita in a press release from the American Society of Nephrology (ASN).

During a median follow-up of 17.5 years, 2,598 of the 9,047 participants were hospitalized with cardiovascular disease: 1,269 with heart failure, 1,337 with atrial fibrillation, 696 with coronary heart disease, and 559 with stroke; 210 patients developed kidney failure.

The incidence of major CVD was associated with a higher risk of kidney failure, with the highest risk for heart failure (hazard ratio, 11.40; 95% confidence interval, 8.38 to 15.50), followed by coronary heart disease, atrial fibrillation, and stroke.

Participants hospitalized with heart failure had an 11.4-times higher risk for kidney failure than participants without cardiovascular disease.

The association was “nominally” stronger for heart failure with preserved ejection fraction (HFpEF) vs HF with reduced EF (HFrEF). 

The authors stress that the findings are cautionary for several reasons. Patients with CVD should be recognized as at high-risk for ESRD and clinicians treating the former will want to “…minimize treatments that are toxic to the kidneys in such individuals,” said Dr Ishigami in speaking with the ASN. 

Dr Ishigami adds that the team’s findings “…may have implications for monitoring kidney function, although current cardiovascular disease guidelines do not necessarily specify the frequency of evaluating kidney function following the incidence of cardiovascular disease.”

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