Key result
Advanced CKD linked to up to ~7-fold higher HF hospitalization rates versus the general population.
Why the study?
The study was conducted to explore rates and temporal trends of heart failure in advanced CKD compared to the general population.
What are the 10-year temporal trends in heart failure hospitalization and mortality among patients with advanced CKD compared to the general population?
Cohort (n=54,705)
Yes
What are the 10-year temporal trends in heart failure hospitalization and mortality among patients with advanced CKD compared to the general population?
Effect estimate: 3.7 to 6.8 times higher
Despite declining HF-related mortality, HF hospitalizations are rising rapidly among patients with advanced CKD, highlighting a growing disease burden that outpaces the general population.
Highlights growing HF hospitalization burden in advanced CKD; extends temporal trend data and leaves open targeted prevention trials.
Introduction This study explores rates and temporal trends of HF in advanced CKD compared to the general population (GP). Methods We included all patients with non-dialysis dependent CKD stage G4 (N=25,591) and G5 (N=13,968), on hemodialysis (N=10,635) and peritoneal dialysis (N=4,511) enrolled in the Swedish Renal Registry during 2011-2021. Outcomes included HF-related hospitalization and HF-related mortality. Patients were followed until the event, death, or progression to a more severe CKD-stage/change of dialysis modality. Poisson models to estimate unadjusted incidence rates (IR) and IR standardized to an age- sex-matched GP. Results Rates of HF-related hospitalization increased with more advanced stages of CKD, ranging from 3.7 to 6.8 times higher than in the GP. Between 2011 and 2021, RASi and beta-blocker use remained stable and relatively low (44.5% to 70% for RASi), whereas diuretic prescription declined in ND-CKD. This paralleled an important increase in the rates of HF-related hospitalization in CKD stage 4 (+51%), 5-ND (+36%) and HD (+30%), with a larger increase than that observed in the GP. In contrast, HF-related mortality steadily declined in both non-dialysis CKD (up to -20.8% in CKD stage 4) and dialysis dependent CKD (up to -66% in HD), although slower than in the GP. Conclusions Despite decline in HF-related mortality over the past decade – although slower than in the GP – HF-related hospitalization rates have risen substantially in advanced CKD, with a faster increase than in the GP. These findings highlight the growing HF burden in CKD, and the need for targeted prevention and management strategies.
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Lankinen et al. (2026) conducted a cohort in Advanced chronic kidney disease (n=54,705). Advanced CKD vs. General population was evaluated on HF-related hospitalization and HF-related mortality (3.7 to 6.8 times higher). Advanced CKD was associated with heart failure hospitalization rates 3.7 to 6.8 times higher than the general population, with hospitalizations increasing by up to 51% between 2011 and 2021.
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