Major cardiovascular disease (CVD) events, especially heart failure, are independently associated with development of end-stage renal disease (ESRD), investigators reported in the Journal of the American Society of Nephrology.

Junichi Ishigami, MD, of Johns Hopkins University in Baltimore, and colleagues studied 9047 individuals (mean age 63 years; 78% white; 22% black) initially free of CVD and ESRD (or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2) from the Atherosclerosis Risk in Communities (ARIC) study. During a median 17.5 years, 2598 participants (29%) were hospitalized with at least 1 CVD subtype: 1269 with heart failure; 1337 with atrial fibrillation; 696 with coronary heart disease (CHD); and 559 with stroke. ESRD developed in 210 participants (2.3%), including 134 cases following CVD events and 76 cases without CVD.

After adjusting for age, sex, and race, CVD overall, heart failure, atrial fibrillation, and CHD was significantly associated with an 11.6-, 22.9-, 4.2-, 4.9-, and 2.2-fold increased risk of ESRD compared with the absence of CVD. After further adjustment for body mass index, blood pressure, cholesterol, diabetes, and other numerous other factors, the presence of heart failure, atrial fibrillation, and CHD was significantly associated with 11.4-, 2.7-, and 3.7-fold increased risks for ESRD, respectively, compared with no CVD. Stroke was associated with a nonsignificant 1.4-fold increased risk for ESRD.  

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In a fully adjusted model that included CVD subtype (atrial fibrillation, CHD, and stroke for analysis of heart failure), patients hospitalized for heart failure and coronary heart disease had significant 9.9- and 1.8-fold increased risks for ESRD, respectively, compared with those who had no CVD. In that same model, atrial fibrillation and stroke were not significantly associated with ESRD risk.

The cumulative incidence of ESRD among participants with heart failure was approximately 10% at 5 years and 15% at 10 years, which is consistent with previous research. The association was stronger for heart failure with preserved rather than reduced ejection fraction. In a fully adjusted model, individuals who had heart failure with preserved ejection fraction had a 7.6-fold increased risk of ESRD, whereas those with heart failure with reduced ejection fraction had a 5.6-fold increased risk.

“These findings highlight the importance of managing kidney disease after cardiovascular disease,” Dr Ishigami’s team wrote. Physicians should minimize nephrotoxic exposures, such as nonsteroidal anti-inflammatory drugs and certain antibiotics, and should monitor kidney function, they noted.

Why ESRD more commonly occurs after heart failure with preserved rather than reduced ejection fraction deserves future investigation, according to the researchers.

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Ishigami J, Cowan LT, Demmer RT, et al. Incident hospitalization with major cardiovascular diseases and subsequent risk of ESKD: Implications for cardiorenal syndrome. J Am Soc Nephrol. doi: 10.1681/ASN.2019060574