Different impact of chronic kidney disease in older patients with heart failure according to frailty.

Autor: Díez-Villanueva P; Cardiology Deparment, Hospital Universitario de la Princesa, Madrid, Spain. Electronic address: pablo_diez_villanueva@hotmail.com., Jiménez-Méndez C; Cardiology Deparment, Hospital Universitario Puerta del Mar, Cádiz, Spain., Pérez-Rivera Á; Cardiology Deparment, Hospital Universitario de Burgos, Burgos, Spain., Barge Caballero E; Cardiology Deparment, Complejo Universitario de A Coruña, A Coruña, Spain., López J; Cardiology Deparment, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Ortiz C; Cardiology Deparment, Hospital Universitario Fundación de Alcorcón, Madrid, Spain., Bonanad C; Cardiology Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain., Goirigolzarri J; Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain., Esteban Fernández A; Cardiology Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain., Cobo M; Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Montes N; Instituto de Investigación Sanitaria (ISS-IP) & Rheumathology Department, Hospital Universitario La Princesa, Madrid, Spain; Plant Physiology, Pharmaceutical and Health Sciences Department, Faculty of Pharmacy, Universidad San Pablo-CEU, CEU-Universities, Madrid, Spain., Ariza-Solé A; Cardiology Deparment, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain., Martínez-Sellés M; Cardiology Deparment, Hospital Universitario Gregorio Marañón, Madrid, Spain., Alfonso F; Cardiology Deparment, Hospital Universitario de la Princesa, Madrid, Spain.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2024 Dec 07. Date of Electronic Publication: 2024 Dec 07.
DOI: 10.1016/j.ejim.2024.12.001
Abstrakt: Background: Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model.
Results: We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m 2 . Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m 2 , 182 patients, 36 %), moderately impaired (eGFR 30-59 ml/min/1.72m 2 , 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m 2 , 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality.
Conclusions: Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.
Competing Interests: Declaration of competing interest The Authors declare that there is no conflict of interest
(Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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