MO763: Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure

Abstract BACKGROUND AND AIMS Hemodialysis (HD) is a unique treatment modality that offers a life-sustaining treatment option for patients with end-stage kidney disease (ESKD). However, the mortality of HD patients is still unacceptably high compared with the general population. Cardiovascular diseases (CVDs) (including myocardial infarction, heart failure and stroke) are the leading causes of death in dialysis-dependent ESKD patients, accounting for ∼40% of the mortality. Congestive heart failure (CHF) is a final common clinical pathway for several diseases. HD patients are at 12–36× risk for the development of CHF. In the general population, CHF increases the risk of death. However, there is no well-designed relevant study in the Chinese HD population addressing the risks associated with CHF. The aim of this study was to explore the impact of CHF on the clinical outcomes in HD patients. METHOD The DOPPS is an international prospective cohort study of in-center adult HD patients. China joined DOPPS in 2011. DOPPS China randomly selected an average of 30 patients from 15 dialysis facilities in each city of Beijing, Shanghai and Guangzhou. There were 1427 patients who participated in China DOPPS5 (2012–2015). Of the 1427 patients, 16 patients were excluded from the present analysis as their CHF history information was missing. Demographic data, comorbidity, Lab data and death records were extracted. CHF was defined by the diagnosis records upon study inclusion. Continuous variables were represented as mean ± SD or median (25th, 75th) according to the results of the normality test. Categorical variables were expressed as numbers and percentages. We stratified data by CHF and non-CHF groups. Our primary outcome was associations between CHF and all-cause and cardiovascular (CV) mortality; secondary outcomes were all-cause and cause-specific hospitalization risk. Associations between CHF and outcomes were evaluated using Cox regression models. Cox regression models were with five incremental levels of covariate adjustment. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were carried out. RESULTS Of 1411 patients without missing CHF history information, 24.1% (340) had a CHF diagnosis at enrollment. In this cohort, male patients accounted for 54.9% of the patients. The median age was 60.0 (inter-quartile range, IQR 49.0–71.0) years and the median dialysis vintage was 2.6 (IQR 0.9–5.4, Table 1) years. The median follow-up period was 1.9 (IQR 1.2–2.1) years. Altogether, 203 (14.4%) patients died, where 103 (7.3%) died from CV disease. The CV death constituted half of the patient’s mortality. The overall mortality rates were 21.8% versus 12.0% (P < 0.001) in patients with and without CHF during entire follow-up, respectively. CHF was associated for higher all-cause mortality [adjusted HR 1.72, 95% confidence interval (95% CI) 1.17–2.53; P = 0.006, Fig. 1], and the association with CV death was of similar magnitude (HR 1.60, 95% CI 0.91–2.81; P = 0.105). CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49– 5.76; P <0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR 1.09, 95% CI 0.90–1.33; P = 0.39). CONCLUSION In this prospective cohort study, the prevalence of CHF was identified to be around one quarter, and all-cause mortality in patients with combined CHF and HD was found to be higher. CHF was associated with an increased risk of all-cause mortality and a cause-specific hospitalization risk in HD patients. The associations were not affected by adjustment for several potential confounding factors. Thus, CHF is found to be an outcome predictor for HD patients, and measures should be adopted to improve care for these patients to improve their survival.