Burden and Outcomes of Heart Failure Hospitalizations Among Adults on Dialysis

Background: Among patients on dialysis, heart failure (HF) is the most prevalent cardiovascular comorbidity, yet the types of HF and risk across dialysis modality remain poorly elucidated. We examined the rates of HF hospitalizations, 30-day HF readmissions and all-cause mortality in a large dialysis cohort overall, by dialysis modality and across HF subtypes. Methods: We studied 1,238 Chronic Renal Insufficiency Cohort (CRIC) participants who developed end-stage kidney disease (ESKD) and were treated with either hemodialysis (HD) or peritoneal dialysis (PD). The primary outcome was HF hospitalization. Secondary outcomes included the rate of HF with preserved vs reduced ejection fraction (HFpEF vs HFrEF), with HFpEF defined as left ventricular ejection fraction ≥ 50%. We used Poisson regression to estimate relative risk and Cox regression to assess the association between HF subtype and mortality. Results: Among 1,238 participants (mean age 62.3 years; 85% on HD), median time to first HF hospitalization was 1.8 (IQR 0.4-3.7) years and time from dialysis start to either death/censorship was 5.3 (IQR 2.3-9.9) years. HF hospitalization rate was 10.2 (95% CI 8.4-11.9) per 100 person-years (pys) and 30-day HF rehospitalization was 2.0 (95% CI 1.3-2.8). No significant differences were found between HD and PD for HF hospitalizations (aRR 0.94, p=0.84) or 30-day HF readmissions (aRR 1.42, p=0.52).Rates of HFpEF vs HFrEF were similar (RD 0.7/100 pys, 95% CI -0.2 to 1.5) (Figure 1). Mortality rate was higher in HFrEF vs HFpEF (17.3 vs 11.3/100 pys) but the risk was not statistically significant after adjustment (p=0.84) (Table 1). Conclusion: Patients with ESKD and HF have high HF hospitalization rates and poor survival. Our study found no significant differences in HF risk by dialysis modality. Rates of HFpEF and HFrEF were similarly common and linked to all-cause mortality. Dedicated trials, including randomized comparisons of dialysis modalities, are needed in this population. Funding: Other NIH Support - NIH NCOR-KUH, 1U2CDK140919-01