Increased Inpatient Dialysis Initiation Among CKD Patients with Heart Failure

Recent research indicates that patients suffering from chronic kidney disease (CKD) in conjunction with heart failure exhibit a markedly higher rate of initiating inpatient dialysis compared to those without heart failure. This finding was published in a study available in the renowned Mayo Clinic Proceedings.

A cross-sectional analysis was conducted involving CKD patients aged 18 years and older within the Kaiser Permanente Southern California health system. The study reviewed data from individuals who began maintenance dialysis between January 1, 2007, and December 31, 2018, aiming to understand the patterns of dialysis transitions, particularly focusing on inpatient initiations.

Out of the 6,812 CKD patients included in the study, 37% were also diagnosed with heart failure. The findings revealed that 18.5% of patients with heart failure initiated dialysis during their hospital stay, in contrast to only 9.6% of patients without heart failure. Furthermore, the average estimated glomerular filtration rate at the time of dialysis initiation was 11.3 mL/min/1.73 m² for those with heart failure, compared to 9.4 mL/min/1.73 m² for those without heart failure.

Among the subset of 5,499 patients who started hemodialysis, the usage of central venous catheters (CVC) was reported in 58.5% of those with heart failure, while 51.9% of those without heart failure utilized CVCs. The data suggested that patients with heart failure had a multivariate rate ratio of 1.46 for inpatient dialysis initiation, indicating a significant association between heart failure and the likelihood of starting dialysis in a hospital setting. The rate ratio for CVC placement was also higher, at 1.23, specifically for patients with heart failure accompanied by reduced ejection fraction.

The authors of the study concluded that CKD patients diagnosed with heart failure are more prone to initiate dialysis in conditions that demand greater healthcare resources and are linked to a higher risk of less favorable outcomes. The research emphasizes the pressing need for healthcare providers to closely monitor CKD patients who also present with heart failure, given their increased likelihood of requiring inpatient dialysis services.