The coexistence of chronic kidney disease (CKD) and heart failure (HF) is common, yet the long-term epidemiology and healthcare utilization associated with CKD in HF populations remain insufficiently characterized. A 5-year longitudinal cohort analysis published in Heart evaluated outcomes among patients hospitalized for HF who were enrolled in the Patient Centered Care Transitions in HF randomized controlled trial.

The study included 4,441 patients hospitalized for HF. CKD status was determined at the index hospitalization using linked administrative databases. Clinical outcomes, healthcare resource utilization, and direct healthcare costs were compared between patients with and without CKD at baseline. Survival analyses were conducted using Cox proportional hazards models adjusted for baseline characteristics.

Among the cohort, 929 patients (20.9%) had an established CKD diagnosis at index HF hospitalization. Patients with CKD experienced higher adjusted mortality risk compared with those without CKD (adjusted hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.42–1.69). Mean survival was shorter in the CKD group (2.2 ± 1.8 vs 3.0 ± 1.9 years). CKD was also associated with higher healthcare utilization, including more rehospitalizations (4.5 ± 12.2 vs 2.5 ± 6.6 per patient) and longer cumulative in-hospital stays (43.8 ± 61.8 vs 22.7 ± 42.3 days). Patients with CKD were also less likely to receive an ACE inhibitor or mineralocorticoid receptor antagonist after adjustment for baseline characteristics. Annual healthcare costs were nearly twice as high among patients with CKD (C$128,840 vs C$67,937 per year), largely driven by rehospitalizations. Additionally, among patients without CKD at baseline, at least 83.4% received a CKD diagnosis during follow-up.

CKD at index HF hospitalization was associated with higher mortality, shorter survival, and greater healthcare utilization. CKD diagnoses also frequently emerged during follow-up among patients initially without CKD.