Illustration of a cross section of human kidneys to illustrate kidney disease
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Researchers from the Brigham and Women’s Hospital, reporting today in the journal JAMA Cardiology, have found links between patients admitted to the hospital for heart failure and a higher risk of kidney disease. The broad-based study, conducted across 372 participating sites, included adults 65 years and older hospitalized for heart failure and found a substantial risk of kidney complications with roughly six percent of patients requiring dialysis within a year of hospitalization.

“We know that heart and kidney health are highly interconnected, but management of heart and kidney disease remains relatively siloed, and kidney health often isn’t prioritized in patients with heart disease until advanced stages,” said first author John Ostrominski, MD, a fellow in cardiovascular medicine and obesity medicine at the Brigham.

Nearly two-in-three people with heart failure have impaired kidney function, but few studies have been conducted to date to better understand the occurrence of kidney health effects such as hospitalization or acute kidney injury or the need for dialysis in heart failure patients.

“Declining kidney function is often asymptomatic until late in the disease course, but even less advanced stages of kidney impairment can have important implications for cardiovascular health,” Ostrominski added. “Hence, there’s a need for analyses that assess kidney outcomes in people with heart failure.” A better understanding of the relationship between the two conditions could result in broad changes to the clinical co-management of these morbidities.

The Brigham study looked at Medicare claims data from more than 85,000 patients over the age of 65 who were hospitalized with heart failure between 2021 and 2024. Data used had been aggregated in the Get with the Guidelines-Heart-Failure Registry, an American Heart Association-supported project with a goal of providing hospitals with evidence-based guidelines to improve the quality of cardiac care.

The data showed that 63 percent of patients hospitalized with heart failure showed significantly impaired kidney function at discharge and that the risk of adverse kidney outcomes showed significant increases in patients with lower kidney function. In addition to the six percent of patients who progressed to dialysis within one year of discharge, seven percent of patients were either on dialysis or had progressed to end-stage kidney disease.

In their published report, the Brigham team noted the need to create better integrated care models that support both heart and kidney health, and perhaps establish specialized clinics that focus solely on these comorbidities. Investigators at Mass General Brigham have established a clinical study site to help develop new treatment strategies to coordinate care for heart failure to reduce the risk of kidney disease in patients.

“The trends we’ve observed aren’t especially surprising given what we know about the links between heart and kidney health,” said Ostrominski, “but what’s important is that this research emphasizes the scope of the problem and gives us information we can act upon to directly improve clinical outcomes in patients with heart failure. There are important opportunities for patients and providers, healthcare institutions, and, at the broader state and national levels, in terms of healthcare policy that could make a big difference for patients.”

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