Why the study?
Neither the AHA/ACC heart failure staging nor the NYHA functional classification system accounts for symptom variability before versus after renal replacement therapy in patients with ESRD. Consequently, the incidence, severity, and outcomes of heart failure in ESRD are poorly characterized, representing a critical unmet need.
The 11th Acute Dialysis Quality Initiative proposes a novel heart failure classification system for patients with end-stage renal disease incorporating echocardiography and patient-reported dyspnea assessed before and after ultrafiltration to address limitations of current NYHA and AHA/ACC staging.
Structural heart disease is highly prevalent in patients with chronic kidney disease requiring dialysis. More than 80% of patients with end-stage renal disease (ESRD) are reported to have cardiovascular disease. This observation has enormous clinical relevance because the leading causes of death for patients with ESRD are of cardiovascular disease etiology, including heart failure, myocardial infarction, and sudden cardiac death. The 2 systems most commonly used to classify the severity of heart failure are the New York Heart Association (NYHA) functional classification and the American Heart Association (AHA)/American College of Cardiology (ACC) staging system. With rare exceptions, patients with ESRD who do not receive renal replacement therapy (RRT) develop signs and symptoms of heart failure, including dyspnea and edema due to inability of the severely diseased kidneys to excrete sodium and water. Thus, by definition, nearly all patients with ESRD develop a symptomatology consistent with heart failure if fluid removal by RRT is delayed. Neither the AHA/ACC heart failure staging nor the NYHA functional classification system identifies the variable symptomatology that patients with ESRD experience depending upon whether evaluation occurs before or after fluid removal by RRT. Consequently, the incidence, severity, and outcomes of heart failure in patients with ESRD are poorly characterized. The 11th Acute Dialysis Quality Initiative has identified this issue as a critical unmet need for the proper evaluation and treatment of heart failure in patients with ESRD. We propose a classification schema based on patient-reported dyspnea assessed both pre- and post-ultrafiltration, in conjunction with echocardiography.
No takes yet. Share an insight, caveat, or question.
Chawla et al. (2014) conducted a review in Heart failure in end-stage renal disease. Pre- and post-ultrafiltration dyspnea and echocardiography classification schema vs. NYHA functional classification and AHA/ACC staging system was evaluated. The 11th Acute Dialysis Quality Initiative proposed a heart failure classification schema using pre- and post-ultrafiltration dyspnea and echocardiography for ESRD patients (>80% with CVD).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: