Key result
Hypertrophic cardiomyopathy independently increased the risk of developing end-stage renal disease by nearly four-fold compared to matched controls (adjusted HR 3.93).
Why the study?
Previous studies have focused on sudden cardiac death in hypertrophic cardiomyopathy, leaving the long-term systemic impact of HCM unclear, including its association with end-stage renal disease.
Does hypertrophic cardiomyopathy increase the risk of incident end-stage renal disease in adults?
Cohort (n=61,800)
Does hypertrophic cardiomyopathy increase the risk of incident end-stage renal disease in adults?
Hazard Ratio: 3.93 (95% CI 2.82–5.46)
Absolute Event Rate: 1.08% vs 0.17%
p-value: p=<0.001
Hypertrophic cardiomyopathy is a strong, independent risk factor for the development of end-stage renal disease, suggesting that active surveillance of renal function is warranted in these patients.
May prompt renal monitoring in HCM; hypothesis-generating and requires prospective validation.
Although hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, has mortality rate as low as general population, previous studies have focused on identifying high-risk of sudden cardiac death. Thus, long-term systemic impact of HCM is still unclear. We sought to investigate the association between HCM and end-stage renal disease (ESRD). This was a nationwide population-based cohort study using the National Health Insurance Service database. We investigated incident ESRD during follow-up in 10,300 adult patients with HCM (age 62.1 years, male 67.3%) and 51,500 age-, sex-matched controls. During follow-up (median 2.8 years), ESRD developed in 197 subjects; 111 (1.08%) in the HCM, and 86 (0.17%) in the non-HCM (incidence rate 4.14 vs. 0.60 per 1,000 person-years, p < 0.001). In the HCM, the incidence rate for ESRD gradually increased with age, but an initial peak and subsequent plateau in age-specific risk were observed. HCM was a significant predictor for ESRD (unadjusted HR 6.90, 95% CI 5.21-9.15, p < 0.001), as comparable to hypertension and diabetes mellitus. Furthermore, after adjusting for all variables showing the association in univariate analysis, HCM itself remained a robust predictor of ESRD development (adjusted HR 3.93, 95% CI 2.82-5.46, p < 0.001). The consistent associations between HCM and ESRD were shown in almost all subgroups other than smokers and subjects with a history of stroke. Conclusively, HCM increased the risk of ESRD, regardless of known prognosticators. It provides new insight into worsening renal function in HCM, and active surveillance for renal function should be considered.
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Lee et al. (2019) conducted a cohort in Hypertrophic cardiomyopathy (n=61,800). Hypertrophic cardiomyopathy vs. Non-hypertrophic cardiomyopathy (matched controls) was evaluated on Incident end-stage renal disease (ESRD) (adjusted HR 3.93, 95% CI 2.82-5.46, p=<0.001). Hypertrophic cardiomyopathy independently increased the risk of developing end-stage renal disease by nearly four-fold compared to matched controls (adjusted HR 3.93).
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