Heart Failure: The Grim Reaper of the Cardio-Renal-Metabolic Triad
Authors' conclusion
In a cohort of CKD patients, having HF contributes substantially to increased mortality and the risk of MACE, and these patients are less likely to start KRT.
Study context
- Population
- Patients with Chronic Kidney Disease (CKD) in the Swedish Renal Registry
- Participants
- 27,647 patients
- Exposure
- CKD with heart failure (HF) and/or diabetes mellitus (DM) vs CKD alone
- Outcome
- All-cause mortality, major adverse cardiovascular events (MACE) (non-fatal MI, hospitalization for congestive HF, non-fatal stroke or CV death) and initiation of kidney replacement therapy
- Follow-up
- Up to 10 years
Methodological detailsnational registry, follow-up up to 10 years, Cox proportional hazards and competing risk models
- National registry
- Follow-up up to 10 years
- Cox proportional hazards and competing risk models
Main finding
As reported in the abstract
All-cause mortality · 5 years
Each group vs CKDAdjusted hazard ratio (95% CI)
CKD/HF
2.57(2.43–2.71)
CKD/HF/DM
3.22(3.05–3.39)
Observational data: associations, not effects.
Further findings
| Outcome | CKD | CKD/DM | CKD/HF | CKD/HF/DM | Estimate | |
|---|---|---|---|---|---|---|
| MACE · up to 10 yearsCKD/HFvs CKDCompeting risk model | 28% | 35% | 67% | 73% | adjusted SHR 3.33 (95% CI 3.14–3.53) | |
| MACE · up to 10 yearsCKD/HF/DMvs CKDCompeting risk model | adjusted SHR 4.26 (95% CI 4.04–4.50) | |||||
| Death prior to KRT initiationCKD/HFvs CKD | SHR 2.05 (95% CI 1.93–2.18) | |||||
| Death prior to KRT initiationCKD/HF/DMvs CKD | SHR 2.43 (95% CI 2.29–2.58) | |||||
| 0.20.5125Ratio (log scale) |
Death prior to kidney replacement therapy (KRT) initiation
- CKD patients with HF less likely to commence KRT
Original publication
Heart Failure: The Grim Reaper of the Cardio-Renal-Metabolic Triad. ESC Heart Fail. Published 24 April 2024. doi:10.
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