End-Stage Chronic Kidney Disease and Heart Failure with Reduced Ejection Fraction: A Bad Association?

Author(s): Meryem HABOUB, Ilyas ATLAS, Hanane MECHAL, Abdenasser DRIGHIL, Rachida HABBAL

Background: The prevalence of congestive heart failure increases greatly as the patient's renal function deteriorates, and, at end-stage chronic kidney disease, can reach 65-70%. There is evidence that chronic kidney disease is a major contributor to severe cardiac damage. The aim of the study is to determine the impact of end-stage chronic kidney disease in patients with heart failure and reduced ejection fraction in a Moroccan population.

Results: We collected 3412 patients, 439 (12%) in group A (with endstage chronic kidney disease) and 2973 (82%) in group B (without endstage chronic kidney disease). Main etiology of heart failure was ischemic heart disease in both groups. Hypertension and dyslipidemia were more prevalent in group A. Diabetes was as prevalent in 2 groups. Comorbidities were more prevalent in group A as we observe more strokes (20% vs 8%, p=0,0001) and myocardial infarctions (31% vs 28%, p=0,0001). Group A patients were more symptomatic: stage III and IV New York Heart Association in 30% vs 19%, p=0,0001. Atrial fibrillation was more prevalent in group A (14% vs 9%, p=0,0001). Elevated left ventricle filling pressure was more prevalent in group A (40% vs 34%, p=0,003). Mean LVEF was 35,69 +/- 12,56 % in group A vs 33,46 +/- 10,42 % in group B (p=0,63). Patients of group A were more at risk of heart failure hospitalization (21% vs 9%, p=0,005).

Conclusions: Cooperation between nephrologists and cardiologists may improve quality of care and subsequent prognosis for heart failure and chronic kidney disease.