SPC365

Cardiorenal Syndrome and Death Risk in Patients with Heart Failure or Chronic Kidney Disease: An Unmet Cardiorenal Need?

Session: Comunicações Orais (Sessão 26) - Insuficiência Cardíaca 4 - Vários Tópicos
Speaker: Tiago Taveira-Gomes

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Tiago Taveira-Gomes; Carla Santos Araújo; Daniel Seabra; Filipa Bernardo; Johan Bodegård; Cristina Gavina

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Heart failure (HF) and chronic kidney disease (CKD) have interlinked pathophysiological pathways and patients having both conditions simultaneously are defined as having cardiorenal syndrome (CRS).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To estimate the risk of CRS in patients with initial presentation of HF (without prior CKD) or CKD (without prior HF) compared to mean age overall population in a real-world clinical setting. Also, to estimate the risk of all-cause death, cardiovascular (CV) death and non-fatal major CV events (MACE) in patients with HF, CKD and CRS compared to the mean-age overall population.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Clinical database analysis of a single primary and secondary healthcare institution from 2008-2019. We defined 4 incident cohorts: <strong>Control</strong> - patients at age 75; <strong>HF</strong> - HF patients without prior CKD; <strong>CKD</strong> - CKD patients without prior HF; <strong>CRS</strong> - patients with HF and CKD. Patients were indexed at the date of first event and followed one year. We defined HF as either: i) Ejection Fraction (EF)&le;40% and NT-proBNP&ge;200pg/mL (&ge;600pg/mL if atrial fibrillation (AF)) <strong>OR</strong> BNP&ge;100pg/mL (&ge;125pg/mL if AF); ii) EF&gt;40% in the presence of structural cardiac abnormalities. We defined CKD as eGFR&le;60mL/min using EPI-CKD formula. All definitions were constructed using laboratory-level data complemented with episode-level data. Hazard ratios (HR) and 95% confidence intervals were estimated using Cox regression models adjusted for age, sex, age-sex interaction, prior history of hypertension, myocardial infarction, stroke, peripheral artery disease and type 2 diabetes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We identified 3973 patients with HF, 13990 with CKD, 6784 with CRS and 16182 controls.&nbsp; Patients were in general 75-77 years old. The majority were females and were well treated with CV risk reducing drugs (Table 1). <strong>All-cause death risk</strong> was 4.7 (4.1-5.2) for HF and 4.9 (4.5-5.4) for CKD. <strong>CV death risk</strong> was 8.6 (6.8-10.8) for HF and 8.7 (7.1-10.6) for CKD. <strong>Non-fatal MACE</strong> <strong>risk</strong> was 7.4 (6.3-8.7) for HF, 4.6 (4.0-5.3) for CKD, and 7.1 (6.1-8.3) for CRS. CRS was associated with the highest risks of all-cause and CV death when compared with the control group - 7.1 (6.4-7.9) and 13.7 (11.7-17.0), respectively (Figure 1). &nbsp;More than half of events occurred in the first 90 days of follow-up for all outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardiorenal disease (HF or CKD) was associated with very high short-term risk (1 year) of developing CRS or death. Consecutively, patients with established CRS had the highest risk of dying. These results demonstrate serious cardiorenal risks in a real-world setting, supporting an urgent need for improved primary and secondary prevention of cardiorenal disease and cardiorenal syndrome.</span></span></p>