Abstract 11651: Risk Factors for Congestive Heart Failure in Patients with Chronic Kidney Disease: the CRIC Study

Abstract

We studied the prospective relationship of novel cardiovascular risk factors with the event rate of congestive heart failure (CHF) among 3,939 patients with chronic kidney disease (CKD) from the Chronic Renal Insufficiency Cohort (CRIC) Study. Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation, serum cystatin C, and 24-hour urinary excretion of albumin. During an average of 3.6 years of follow up, 390 individuals were hospitalized for CHF. After adjustment for age, gender, race, self-reported history of CHF and clinical site, the hazard ratio (HR, 95% CI) for CHF associated with 1 standard deviation (SD) lower eGFR (13.5 mL/min/1.73 m²) was 1.53 (1.35,1.73), 1 SD higher cystatin C (0.55 mg/L) was 1.61 (1.47,1.75), and 1 SD higher log[urine albumin (0.52 mg/24 h)] was 1.62 (1.48, 1.76), all p<0.001. When all 3 kidney function measures were simultaneously included in the model, only cystatin C (HR, 1.53, 95% CI 1.34, 1.74) and log(urine albumin) (HR 1.47, 95% CI 1.35, 1.61) were significantly associated with increased risk of CHF. These associations remained statistically significant after further adjustment for other known risk factors including education, physical activity, cigarette smoking, alcohol consumption, history of myocardial infarction and diabetes, body mass index, systolic blood pressure, HDL and LDL cholesterol. After adjustment for all above mentioned risk factors, the relationships of novel risk factors (1 SD higher) with CHF are given in the table below. Our study indicated that cystatin C and urine albumin are better predictors for risk of CHF compared to eGFR. Furthermore, anemia, inflammation, higher uric acid, and poor glycemic control are independent risk factors for the development of CHF among patients with CKD.