Association of chronic kidney disease with outcomes in chronic heart failure: a propensity-matched study

BACKGROUND: Chronic kidney disease (CKD) is associated with increased mortality in patients with heart failure (HF). However, its association with hospitalization in HF patients has not been well studied. METHODS: Of 7788 patients in the Digitalis Investigation Group trial, 3527 had CKD, defined by an estimated glomerular filtration rate (GFR) or=60 ml/min/1.73 m(2) BSA, HR for all-cause hospitalization for GFR 45-59 and <45 ml/min/1.73 m(2) BSA were respectively 1.04 (95% CI, 0.94-1.16; P = 0.422) and 1.58 (95% CI, 1.34-1.87; P < 0.0001). Similarly, HR for all-cause death for GFR 45-59 and <45 ml/min/1.73 m(2) BSA were respectively 1.03 (95% CI, 0.90-1.18; P = 0.651) and 1.70 (95% CI, 1.40-2.07; P < 0.0001). Matched HR for death due to cardiovascular causes and progressive HF were respectively 1.24 (95% CI, 1.09-1.40; P = 0.001) and 1.42 (95% CI, 1.16-1.72; P = 0.001). CONCLUSION: CKD was associated with increased mortality and hospitalization in ambulatory patients with chronic HF, which increased progressively with worsening kidney function.