Advanced chronic kidney disease was significantly associated with a worse prognosis in acute heart failure patients aged <80 years (P=0.01), but not in those aged ≥80 years (P=0.26).
Cohort (n=764)
No
Does advanced chronic kidney disease worsen the composite of all-cause death and HF rehospitalization in patients hospitalized for acute heart failure, and does this prognostic impact differ by age?
Advanced chronic kidney disease is a strong prognostic marker for adverse outcomes in younger patients (<80 years) hospitalized for acute heart failure, but loses its prognostic significance in patients aged ≥80 years.
p-value: p=0.002
Abstract Introduction Chronic kidney disease (CKD) is a recognized risk factor for adverse clinical outcomes in patients with acute heart failure (AHF). With advancing age, renal reserve capacity diminishes and heart failure risk escalates, contributing to CKD progression. However, the prognostic impact of CKD may differ across different age groups. Elucidating age-related variations in CKD’s impact is crucial for optimizing treatment strategies. Purpose This study aimed to assess the impact of CKD on long-term outcomes in patients hospitalized for AHF and evaluate whether its prognostic significance differs by age. Methods This retrospective, single-center study includedconsecutive patients hospitalized for AHF between 2015 and 2023. CKD was classified based on estimated glomerular filtration rate (eGFR) into three stages: Stage 1-2 (≥60 mL/min/1.73m²), Stage 3a-3b (30-59), and Stage 4-5 (30). Patients were stratified into two age groups: 80 years and ≥80 years. The primary outcome was a composite of all-cause death and HF rehospitalizationafter the discharge of index hospitalization. Results Of the 764 patients, 39% were in Stage 1-2, 43%in Stage 3a-3b, and 18% in Stage 4-5. Kaplan-Meier analysis demonstrated a significant association between CKD severity and prognosis in the overall cohort (Log-rank, P=0.002, Figure A). In patients 80 years, advanced CKD was significantly associated with worse survival rates (P=0.01, Figure B), suggesting that kidney dysfunction plays a major role in prognosis. In contrast, in patients ≥80 years, survival rates did not significantly differ across CKD stages (P=0.26, Figure C), indicating that CKD’s diminished prognostic relevance in older patients. Conclusion In patients hospitalized for AHF, advanced CKD was strongly associated with a worse prognosis in younger patients, while its impact was not significant in those aged ≥80 years. These findings highlight the need for early CKD intervention in younger HF patients, as their prognosis may be more modifiable with aggressive management strategies. In contrast, clinicians should consider overall health status and competing risks when making treatment decisions among elderly patients, as renal function alone may not be a primary determinant of prognosis.
Hashimoto et al. (Sat,) conducted a cohort in Acute heart failure (AHF) (n=764). Advanced chronic kidney disease (CKD) vs. Mild or no chronic kidney disease (Stage 1-2) was evaluated on Composite of all-cause death and HF rehospitalization after the discharge of index hospitalization (p=0.002). Advanced chronic kidney disease was significantly associated with a worse prognosis in acute heart failure patients aged <80 years (P=0.01), but not in those aged ≥80 years (P=0.26).