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Older adults with heart failure have considerable risk for kidney complications, with 6 percent progressing to dialysis at one year after hospitalization, according to a study published online May 29 in JAMA Cardiology.

John W. Ostrominski, M.D., from Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues examined rates of incident dialysis and acute kidney injury (AKI) among Medicare beneficiaries after heart failure hospitalization in a retrospective cohort study involving 85,298 adults aged 65 years or older.

The researchers found that 6, 7, and 7 percent of patients had progressed to dialysis, had progressed to dialysis or end-stage kidney disease, and had been readmitted for AKI, respectively, by one year after heart failure hospitalization. There was a steep increase seen in incident dialysis with lower discharge estimated glomerular filtration rate (eGFR) category: Individuals with an eGFR of 45 to <60 and of <30 versus ≥60 mL/min/1.73 m² had higher rates of dialysis readmission (adjusted hazard ratios, 2.16 and 28.46, respectively). Higher rates of readmission for dialysis, dialysis or end-stage kidney disease, and AKI were observed for lower discharge eGFR (per 10 mL/min/1.73 m² decrease; adjusted hazard ratios, 2.23, 2.34, and 1.25, respectively), with similar findings seen for all-cause mortality, all-cause readmission, and heart failure readmission.

“These findings emphasize the need for health care delivery approaches prioritizing both cardiovascular and kidney health in this high-risk population,” the authors write.

Several authors disclosed ties to the biopharmaceutical industry; the Get With The Guidelines-Heart Failure program is partially sponsored by pharmaceutical companies. This analysis was supported by AstraZeneca.

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