Prognostication of the clinical course of heart failure in elderly patients having chronic kidney disease

Therapy ◽  
2021 ◽  
Vol 9_2021 ◽  
pp. 85-94
Author(s):  
Larina V.N. Larina ◽  
Lunev V.I. Lunev ◽  
Larin V.G. Larin ◽  
Golovko M.G. Golovko M ◽  
Sidorova V.P. Sidorova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Clinical Course

MO554THE EFFECT OF HEMOGLOBIN CHANGES AND THE SEVERITY OF CHRONIC KIDNEY DISEASE IN PHYSICAL FUNCTION IN ELDERLY PATIENTS WITH HEART FAILURE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Takumi Noda ◽  
Kentaro Kamiya ◽  
Nobuaki Hamazaki ◽  
Kohei Nozaki ◽  
Takafumi Ichikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Physical Function ◽  
Gait Speed ◽  
Walking Distance ◽  
Leg Strength ◽  
Patients With Heart Failure ◽  
The Relationship

Abstract Background and Aims Anemia is frequently observed in patients with heart failure (HF) and causes increased hospitalization and mortality rates. Anemia is also associated with and is a major risk factor of impaired physical function and frailty. On the other hand, a high percentage of elderly patients with HF have chronic kidney disease (CKD), which is an aggravating factor for anemia, and the combination of anemia and CKD has been reported to increase physical dysfunction and mortality. However, the relationship between hemoglobin (Hb) changes and physical function during hospitalization in elderly patients with HF is unclear, and the impact of CKD severity on these relationships is also unclear. This study aimed to examine the relationship between Hb changes and physical function during hospitalization in elderly patients with HF. We further examined the relationship when stratified by CKD severity. Method Seven hundred and thirty-seven elderly patients with HF, who underwent changes in Hb and physical function test (leg strength, gait speed, and 6-min walking distance [6MWD]), were included in this study. Using a multiple linear regression model, associations between Hb changes and physical function were assessed. In addition, using a generalized linear mixed model, we divided the HF patients into three groups with eGFR ≥60, 30–60, and <30, and examined whether the severity of CKD was related to the Hb change and physical function. Results The median age of the subjects in this study was 77 years (interquartile range 72–82). Changes in Hb during hospitalization were independent determinants of physical function (leg strength, β: 0.158, P < 0.001; gait speed, β: 0.023, P < 0.001; 6MWD, β: 13.039, P < 0.001), even after accounting for factors related to severity of HF. Moreover, the group with more severe CKD showed significantly lower physical function, although Hb improved (P < 0.001) with respect to leg strength and 6MWD compared with the group with lower CKD stage. Conclusion Hb change during hospitalization was an independent determinant of physical function in patients with HF. Patients with a more severe CKD showed lower leg strength values and 6MWD even if Hb improved.

scholarly journals The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease

2019 ◽  
Vol 35 (5) ◽  
pp. 782-789 ◽  
Author(s):  
Amber O Molnar ◽  
William Petrcich ◽  
Matthew A Weir ◽  
Amit X Garg ◽  
Michael Walsh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Randomized Trials ◽  
Advanced Chronic Kidney Disease ◽  
All Cause Mortality ◽  
Β Blocker ◽  
Β Blockers

Abstract Background Whether the survival benefit of β-blockers in congestive heart failure (CHF) from randomized trials extends to patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 but not receiving dialysis] is uncertain. Methods This was a retrospective cohort study using administrative datasets. Older adults from Ontario, Canada, with incident CHF (median age 79 years) from April 2002 to March 2014 were included. We matched new users of β-blockers to nonusers on age, sex, eGFR categories (>60, 30–60, <30), CHF diagnosis date and a high-dimensional propensity score. Using Cox proportional hazards models, we examined the association of β-blocker use versus nonuse with all-cause mortality. Results We matched 5862 incident β-blocker users (eGFR >60, n = 3136; eGFR 30–60, n = 2368; eGFR <30, n = 358). There were 2361 mortality events during follow-up. β-Blocker use was associated with reduced all-cause mortality [adjusted hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.54–0.64]. This result was consistent across all eGFR categories (>60: adjusted HR 0.55, 95% CI 0.49–0.62; 30–60: adjusted HR 0.63, 95% CI 0.55–0.71; <30: adjusted HR 0.55, 95% CI 0.41–0.73; interaction term, P = 0.30). The results were consistent in an intention-to-treat analysis and with β-blocker use treated as a time-varying exposure. Conclusions β-Blocker use is associated with reduced all-cause mortality in elderly patients with CHF and CKD, including those with an eGFR <30. Randomized trials that examine β-blockers in patients with CHF and advanced CKD are needed.

P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa ◽  
A L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular Ejection ◽  
Hospital Records ◽  
Patients With Heart Failure ◽  
The Mean

Abstract Introduction Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure). Results From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) >60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p<0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p<0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p>0.05). The mean follow up was 33±22 vs 32±23 months (p>0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group Conclusions According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.

Clinical course and related costs of patients with diabetes and heart failure and/or chronic kidney disease

2020 ◽  
Vol 315 ◽  
pp. e269-e270
Author(s):  
A.P. Maggioni ◽  
C. Piccinni ◽  
S. Calabria ◽  
L. Dondi ◽  
G. Ronconi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Course ◽  
Patients With Diabetes

1130-P: Mediators of the Effects of Canagliflozin (CANA) on Heart Failure (HF) and CV Death in Patients with Type 2 Diabetes (T2D) and Chronic Kidney Disease (CKD)

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1130-P
Author(s):  
JINGWEI LI ◽  
BRUCE NEAL ◽  
HIDDO L. HEERSPINK ◽  
CLARE ARNOTT ◽  
CHRISTOPHER CANNON ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease

27-OR: Effect of Canagliflozin on Total Hospitalization for Heart Failure Events in Patients with Type 2 Diabetes and Chronic Kidney Disease

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 27-OR
Author(s):  
JINGWEI LI ◽  
MEG J. JARDINE ◽  
BRUCE NEAL ◽  
HIDDO L. HEERSPINK ◽  
CHRISTOPHER CANNON ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease
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