Association of Early Heart Failure Symptoms and Subsequent Heart Failure Hospitalizations and Mortality among Dialysis Patients

KEY POINTS: Patients treated with dialysis have a high burden of heart failure symptoms and functional limitations. Higher burden of heart failure symptoms are associated with higher rates of subsequent heart failure hospitalizations. Higher burden of symptoms are associated with higher risk of death. BACKGROUND: Diagnosing heart failure (HF) in dialysis patients is challenging because of overlapping symptoms of volume overload. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status questionnaire measuring HF symptoms and functional limitations, with lower scores indicating greater burden. METHODS: We studied 625 Chronic Renal Insufficiency Cohort study participants who developed ESKD and had KCCQ scores post-ESKD diagnosis treated with hemodialysis or peritoneal dialysis. The primary outcomes were rates of HF hospitalization, 30-day HF readmission, and all-cause mortality. KCCQ was modeled dichotomously (40% increase in aRR of all-cause mortality ( P = 0.02). CONCLUSIONS: Higher HF symptom burden and functional limitations at dialysis initiation are independently associated with increased risk of HF hospitalization and all-cause mortality, suggesting that the KCCQ score may help predict outcomes early in the course of treatment.