Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study.
Pubmed ID: 17261405
Pubmed Central ID: PMC2708087
Journal: The American journal of cardiology
Publication Date: Feb. 1, 2007
Affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA. email@example.com
MeSH Terms: Humans, Male, Female, Aged, Risk Factors, Middle Aged, Proportional Hazards Models, Heart Failure, Confidence Intervals, Disease Progression, Prognosis, Follow-Up Studies, Kidney Failure, Chronic, Systole, Cardiotonic Agents, Digitalis Glycosides, Survival Rate, Retrospective Studies, Glomerular Filtration Rate, Diastole, Myocardial Contraction
Grants: K23 AG019211, K23 AG019211-03, R01 HL085561, 1-R01-HL085561-01, K23 AG019211-04, R01 HL085561-01, 1-K23-AG19211-04, K23 AG019211-02, P50 HL077100
Authors: Love TE, Ahmed A, Perry GJ, Aban IB, Sanders PW, Rich MW, Bakris GL, Zile MR, Shlipak MG
Cite As: Ahmed A, Rich MW, Sanders PW, Perry GJ, Bakris GL, Zile MR, Love TE, Aban IB, Shlipak MG. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Am J Cardiol 2007 Feb 1;99(3):393-8. Epub 2006 Dec 8.
- Digitalis Investigation Group (DIG)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
Chronic kidney disease (CKD) is common and is associated with increased mortality in heart failure (HF). However, it is unknown whether the effect of CKD on mortality varies by left ventricular ejection fraction (LVEF). We evaluated the effect of CKD on mortality in patients with systolic (LVEF <or=45%) and diastolic (LVEF >45%) HF. Of the 7,788 patients in the Digitalis Investigation Group trial, 3,527 (45%) had CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2). We calculated the propensity score for CKD for each patient, using a multivariate logistic regression model (c statistic 0.76, postmatch absolute standardized differences <5% for all 32 co-variates). We matched 2,399 pairs of patients with and without CKD with similar propensity scores. There were 757 (rate 1,049/10,000 person-years) and 882 (rate 1,282/10,000 person-years) deaths, respectively, in patients without and with CKD (hazard ratio 1.22, 95% confidence interval 1.09 to 1.36, p <0.0001). CKD-associated mortality was higher in those with diastolic HF (371 extra deaths/10,000 person-years, hazard ratio 1.71, 95% confidence interval 1.21 to 2.41, p = 0.002) than in systolic HF (214 extra deaths/10,000 person-years, hazard ratio 1.19, 95% confidence interval 1.07 to 1.32, p = 0.001), which was significant (adjusted p for interaction = 0.034). A graded association was found between CKD-related deaths and LVEF. The hazard ratios for CKD-associated mortality for the LVEF subgroups of <35%, 35% to 55%, and >55% were 1.15 (95% confidence interval 1.02 to 1.29), 1.35 (95% confidence interval 1.11 to 1.64), and 2.33 (95% confidence interval 1.34 to 4.06). In conclusion, CKD-associated mortality was higher in those with diastolic than systolic HF. Patients with diastolic HF should be evaluated for CKD, and the role of inhibitors of the renin-angiotensin system in these patients needs to be investigated.