Identification and outcomes of KDIGO‐defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure
Aims According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined...
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| Veröffentlicht in: | European journal of heart failure 2024-05, Vol.26 (5), p.1251-1260 |
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| creator | Patel, Samir S. Raman, Venkatesh K. Zhang, Sijian Deedwania, Prakash Zeng‐Treitler, Qing Wu, Wen‐Chih Lam, Phillip H. Bakris, George Moore, Hans Heidenreich, Paul A. Rangaswami, Janani Morgan, Charity J. Cheng, Yan Sheriff, Helen M. Faselis, Charles Mehta, Ravindra L. Anker, Stefan D. Fonarow, Gregg C. Ahmed, Ali |
| description | Aims
According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes.
Methods and results
Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) 30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR |
| doi_str_mv | 10.1002/ejhf.3210 |
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According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes.
Methods and results
Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (n = 185 821) or urinary albumin‐to‐creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45–59 (n = 72 606), 30–44 (n = 74 812), 15–29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2. Five‐year all‐cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all‐cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62–1.65), 2.00 (1.98–2.02), 2.49 (2.45–2.52), 2.28 (2.21–2.35), and 1.22 (1.20–1.24), respectively. Respective age‐adjusted HRs (95% CIs) were 1.13 (1.12–1.14), 1.36 (1.34–1.37), 1.87 (1.84–1.89), 2.24 (2.18–2.31) and 1.19 (1.17–1.21), and multivariable‐adjusted HRs (95% CIs) were 1.11 (1.10–1.12), 1.24 (1.22–1.25), 1.46 (1.43–1.48), 1.42 (1.38–1.47), and 1.13 (1.11–1.16). Similar patterns were observed for associations with hospitalizations.
Conclusion
Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO‐defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria.
Outcomes of Kidney Disease: Improving Global Outcomes (KDIGO)‐defined chronic kidney disease (CKD) criteria in 1.4 million U.S. Veterans with heart failure (HF). eGFR, estimated glomerular filtration rate (ml/min/1.73 m2); EHR, electronic health record; KRT, kidney replacement therapy; uACR, urinary albumin‐to‐creatinine ratio (mg/g); VA, U.S. Department of Veterans Affairs.</description><identifier>ISSN: 1388-9842</identifier><identifier>ISSN: 1879-0844</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.3210</identifier><identifier>PMID: 38700246</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Chronic kidney disease ; Creatinine - blood ; Female ; Glomerular Filtration Rate ; Heart failure ; Heart Failure - epidemiology ; Heart Failure - physiopathology ; Humans ; KDIGO ; Male ; Middle Aged ; Outcomes ; Renal Insufficiency, Chronic - epidemiology ; Renal Insufficiency, Chronic - physiopathology ; Retrospective Studies ; United States - epidemiology ; Veterans - statistics & numerical data</subject><ispartof>European journal of heart failure, 2024-05, Vol.26 (5), p.1251-1260</ispartof><rights>2024 European Society of Cardiology This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3250-6ff02d977a0e58e8e63d274356dbb3d2c164d14b8c5bbed4914c8ce2b8acd8363</citedby><cites>FETCH-LOGICAL-c3250-6ff02d977a0e58e8e63d274356dbb3d2c164d14b8c5bbed4914c8ce2b8acd8363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.3210$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.3210$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38700246$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Samir S.</creatorcontrib><creatorcontrib>Raman, Venkatesh K.</creatorcontrib><creatorcontrib>Zhang, Sijian</creatorcontrib><creatorcontrib>Deedwania, Prakash</creatorcontrib><creatorcontrib>Zeng‐Treitler, Qing</creatorcontrib><creatorcontrib>Wu, Wen‐Chih</creatorcontrib><creatorcontrib>Lam, Phillip H.</creatorcontrib><creatorcontrib>Bakris, George</creatorcontrib><creatorcontrib>Moore, Hans</creatorcontrib><creatorcontrib>Heidenreich, Paul A.</creatorcontrib><creatorcontrib>Rangaswami, Janani</creatorcontrib><creatorcontrib>Morgan, Charity J.</creatorcontrib><creatorcontrib>Cheng, Yan</creatorcontrib><creatorcontrib>Sheriff, Helen M.</creatorcontrib><creatorcontrib>Faselis, Charles</creatorcontrib><creatorcontrib>Mehta, Ravindra L.</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Fonarow, Gregg C.</creatorcontrib><creatorcontrib>Ahmed, Ali</creatorcontrib><title>Identification and outcomes of KDIGO‐defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims
According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes.
Methods and results
Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (n = 185 821) or urinary albumin‐to‐creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45–59 (n = 72 606), 30–44 (n = 74 812), 15–29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2. Five‐year all‐cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all‐cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62–1.65), 2.00 (1.98–2.02), 2.49 (2.45–2.52), 2.28 (2.21–2.35), and 1.22 (1.20–1.24), respectively. Respective age‐adjusted HRs (95% CIs) were 1.13 (1.12–1.14), 1.36 (1.34–1.37), 1.87 (1.84–1.89), 2.24 (2.18–2.31) and 1.19 (1.17–1.21), and multivariable‐adjusted HRs (95% CIs) were 1.11 (1.10–1.12), 1.24 (1.22–1.25), 1.46 (1.43–1.48), 1.42 (1.38–1.47), and 1.13 (1.11–1.16). Similar patterns were observed for associations with hospitalizations.
Conclusion
Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO‐defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria.
Outcomes of Kidney Disease: Improving Global Outcomes (KDIGO)‐defined chronic kidney disease (CKD) criteria in 1.4 million U.S. Veterans with heart failure (HF). eGFR, estimated glomerular filtration rate (ml/min/1.73 m2); EHR, electronic health record; KRT, kidney replacement therapy; uACR, urinary albumin‐to‐creatinine ratio (mg/g); VA, U.S. Department of Veterans Affairs.</description><subject>Aged</subject><subject>Chronic kidney disease</subject><subject>Creatinine - blood</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Heart failure</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>KDIGO</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcomes</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><subject>Veterans - statistics & numerical data</subject><issn>1388-9842</issn><issn>1879-0844</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kLtOwzAYRi0E4j7wAsgjDAl27CTOiIDSAhIDlzVy7N-qS-KAnQh14xF4Rp6EhBY2pu8bjs5wEDqiJKaEJGewmJuYJZRsoF0q8iIigvPN4TMhokLwZAfthbAghOYDvo12mBgPz3ZRP9PgOmuskp1tHZZO47bvVNtAwK3Bt5ez6_uvj08NxjrQWM1966zCL1Y7WGJtA8gA2DpMY44bW9ej5Sl-iPEzdOClC_jddnM8B-k7bKStew8HaMvIOsDhevfR0-Tq8WIa3d1fzy7O7yLFkpREmTEk0UWeSwKpAAEZ00nOWZrpqhquohnXlFdCpVUFmheUK6EgqYRUWrCM7aOTlffVt289hK5sbFBQ19JB24eSkZQUTNBsRE9XqPJtCB5M-eptI_2ypKQcK5dj5XKsPLDHa21fNaD_yN-sA3C2At5tDcv_TeXVzXTyo_wGNVyH2Q</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Patel, Samir S.</creator><creator>Raman, Venkatesh K.</creator><creator>Zhang, Sijian</creator><creator>Deedwania, Prakash</creator><creator>Zeng‐Treitler, Qing</creator><creator>Wu, Wen‐Chih</creator><creator>Lam, Phillip H.</creator><creator>Bakris, George</creator><creator>Moore, Hans</creator><creator>Heidenreich, Paul A.</creator><creator>Rangaswami, Janani</creator><creator>Morgan, Charity J.</creator><creator>Cheng, Yan</creator><creator>Sheriff, Helen M.</creator><creator>Faselis, Charles</creator><creator>Mehta, Ravindra L.</creator><creator>Anker, Stefan D.</creator><creator>Fonarow, Gregg C.</creator><creator>Ahmed, Ali</creator><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202405</creationdate><title>Identification and outcomes of KDIGO‐defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure</title><author>Patel, Samir S. ; Raman, Venkatesh K. ; Zhang, Sijian ; Deedwania, Prakash ; Zeng‐Treitler, Qing ; Wu, Wen‐Chih ; Lam, Phillip H. ; Bakris, George ; Moore, Hans ; Heidenreich, Paul A. ; Rangaswami, Janani ; Morgan, Charity J. ; Cheng, Yan ; Sheriff, Helen M. ; Faselis, Charles ; Mehta, Ravindra L. ; Anker, Stefan D. ; Fonarow, Gregg C. ; Ahmed, Ali</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3250-6ff02d977a0e58e8e63d274356dbb3d2c164d14b8c5bbed4914c8ce2b8acd8363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Chronic kidney disease</topic><topic>Creatinine - blood</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Heart failure</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>KDIGO</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcomes</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><topic>Veterans - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Samir S.</creatorcontrib><creatorcontrib>Raman, Venkatesh K.</creatorcontrib><creatorcontrib>Zhang, Sijian</creatorcontrib><creatorcontrib>Deedwania, Prakash</creatorcontrib><creatorcontrib>Zeng‐Treitler, Qing</creatorcontrib><creatorcontrib>Wu, Wen‐Chih</creatorcontrib><creatorcontrib>Lam, Phillip H.</creatorcontrib><creatorcontrib>Bakris, George</creatorcontrib><creatorcontrib>Moore, Hans</creatorcontrib><creatorcontrib>Heidenreich, Paul A.</creatorcontrib><creatorcontrib>Rangaswami, Janani</creatorcontrib><creatorcontrib>Morgan, Charity J.</creatorcontrib><creatorcontrib>Cheng, Yan</creatorcontrib><creatorcontrib>Sheriff, Helen M.</creatorcontrib><creatorcontrib>Faselis, Charles</creatorcontrib><creatorcontrib>Mehta, Ravindra L.</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Fonarow, Gregg C.</creatorcontrib><creatorcontrib>Ahmed, Ali</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Samir S.</au><au>Raman, Venkatesh K.</au><au>Zhang, Sijian</au><au>Deedwania, Prakash</au><au>Zeng‐Treitler, Qing</au><au>Wu, Wen‐Chih</au><au>Lam, Phillip H.</au><au>Bakris, George</au><au>Moore, Hans</au><au>Heidenreich, Paul A.</au><au>Rangaswami, Janani</au><au>Morgan, Charity J.</au><au>Cheng, Yan</au><au>Sheriff, Helen M.</au><au>Faselis, Charles</au><au>Mehta, Ravindra L.</au><au>Anker, Stefan D.</au><au>Fonarow, Gregg C.</au><au>Ahmed, Ali</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification and outcomes of KDIGO‐defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2024-05</date><risdate>2024</risdate><volume>26</volume><issue>5</issue><spage>1251</spage><epage>1260</epage><pages>1251-1260</pages><issn>1388-9842</issn><issn>1879-0844</issn><eissn>1879-0844</eissn><abstract>Aims
According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes.
Methods and results
Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (n = 185 821) or urinary albumin‐to‐creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45–59 (n = 72 606), 30–44 (n = 74 812), 15–29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2. Five‐year all‐cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all‐cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62–1.65), 2.00 (1.98–2.02), 2.49 (2.45–2.52), 2.28 (2.21–2.35), and 1.22 (1.20–1.24), respectively. Respective age‐adjusted HRs (95% CIs) were 1.13 (1.12–1.14), 1.36 (1.34–1.37), 1.87 (1.84–1.89), 2.24 (2.18–2.31) and 1.19 (1.17–1.21), and multivariable‐adjusted HRs (95% CIs) were 1.11 (1.10–1.12), 1.24 (1.22–1.25), 1.46 (1.43–1.48), 1.42 (1.38–1.47), and 1.13 (1.11–1.16). Similar patterns were observed for associations with hospitalizations.
Conclusion
Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO‐defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria.
Outcomes of Kidney Disease: Improving Global Outcomes (KDIGO)‐defined chronic kidney disease (CKD) criteria in 1.4 million U.S. Veterans with heart failure (HF). eGFR, estimated glomerular filtration rate (ml/min/1.73 m2); EHR, electronic health record; KRT, kidney replacement therapy; uACR, urinary albumin‐to‐creatinine ratio (mg/g); VA, U.S. Department of Veterans Affairs.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>38700246</pmid><doi>10.1002/ejhf.3210</doi><tpages>10</tpages></addata></record> |
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| subjects | Aged Chronic kidney disease Creatinine - blood Female Glomerular Filtration Rate Heart failure Heart Failure - epidemiology Heart Failure - physiopathology Humans KDIGO Male Middle Aged Outcomes Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - physiopathology Retrospective Studies United States - epidemiology Veterans - statistics & numerical data |
| title | Identification and outcomes of KDIGO‐defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure |
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