Symptoms characteristic of heart failure among CKD patients without diagnosed heart failure

Abstract

Background: Epidemiological studies typically diagnose heart failure (HF) at the time of hospitalization, and have not evaluated the prevalence of HF symptoms in CKD patients without a prior HF diagnosis.

Methods and results: We modified the Kansas City Cardiomyopathy Questionnaire (KCCQ) to detect and quantify symptoms characteristic of HF (dyspnea, edema, and fatigue) among 2883 chronic kidney disease (CKD) patients without diagnosed heart failure in the Chronic Renal Insufficiency Cohort (CRIC). The KCCQ is a 23-item instrument that quantifies the impact of dyspnea, fatigue, and edema on physical, social, and emotional functions (scored 0 to 100). The median KCCQ score was 92, and 25% had KCCQ scores <75. Compared with cystatin C‑based estimated glomerular filtration rate >50 mL·min·1.73 m(2) (reference), estimated glomerular filtration rate 40 to 50, 30 to 40, and <30 were independently associated with lower KCCQ scores (<75); adjusted odds ratios and (95% CI): 1.38 (1.06-1.78), 1.39 (1.09-1.82), and 2.15 (1.54-3.00), respectively. Lower hemoglobin (Hb) levels also had independent associations with KCCQ <75: Hb >14 g/dL (reference), Hb 13 to 14 g/dL (1.03; 0.76-1.40), Hb 12 to 13 g/dL (1.41; 1.04-1.91), Hb 11 to 12 g/dL (1.56; 1.12-2.16); and Hb <1 g/dL (1.65; 1.15-2.37).

Conclusion: CKD patients without diagnosed HF have a substantial burden of symptoms characteristic of HF, particularly among those with lower estimated glomerular filtration rate and hemoglobin levels.

Conflict of interest statement

Disclosures:

None of the authors have any conflicts of interest to disclose.

Published by Elsevier Inc.

Figures

Figure 1

Figure 1a and 1b: Distribution of KCCQ Score among CRIC Participants without and with Self-Reported Heart Failure

Figure 1

Figure 1a and 1b: Distribution of KCCQ Score among CRIC Participants without and with Self-Reported Heart Failure

Figure 2

Figure 2a–2c: Joint Associations with KCCQ Overall Score of creatinine-based estimated GFR (Figure 2a), cystatin C-based estimated GFR (Figure 2b), and hemoglobin levels (Figure 2c)

Figure 2

Figure 2a–2c: Joint Associations with KCCQ Overall Score of creatinine-based estimated GFR (Figure 2a), cystatin C-based estimated GFR (Figure 2b), and hemoglobin levels (Figure 2c)

Figure 2

Figure 2a–2c: Joint Associations with KCCQ Overall Score of creatinine-based estimated GFR (Figure 2a), cystatin C-based estimated GFR (Figure 2b), and hemoglobin levels (Figure 2c)

Figure 3

Figure 3a–3c: Proportion with KCCQ Score <75, by Categories of Creatinine eGFR (Figure 3a), cystatin C eGFR (Figure 3b), and hemoglobin (Figure 3c)

Figure 3

Figure 3a–3c: Proportion with KCCQ Score <75, by Categories of Creatinine eGFR (Figure 3a), cystatin C eGFR (Figure 3b), and hemoglobin (Figure 3c)