{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:55:56Z","timestamp":1793836556334,"version":"4.6.1"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec id=\"ab-hbr240004-4\"><jats:title>Importance<\/jats:title><jats:p>Kidney health has received increasing focus as part of comprehensive heart failure (HF) treatment efforts. However, the occurrence of clinically relevant kidney outcomes in contemporary populations with HF has not been well studied.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr240004-5\"><jats:title>Objective<\/jats:title><jats:p>To examine rates of incident dialysis and acute kidney injury (AKI) among Medicare beneficiaries after HF hospitalization.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr240004-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study evaluated adults aged 65 years or older who were hospitalized for HF across 372 sites in the Get With The Guidelines\u2013Heart Failure registry in the US between January 1, 2014, and December 31, 2018. Patients younger than 65 years or requiring dialysis either during or prior to hospitalization were excluded. Data were analyzed from May 4, 2021, to March 8, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr240004-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was inpatient dialysis initiation in the year after HF hospitalization and was ascertained via linkage with Medicare claims data. Other all-cause and cause-specific hospitalizations were also evaluated. The covariate-adjusted association between discharge estimated glomerular filtration rate (eGFR) and 1-year postdischarge outcomes was examined using Cox proportional hazards regression models.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr240004-8\"><jats:title>Results<\/jats:title><jats:p>Overall, among 85\u202f298 patients included in the analysis (mean [SD] age, 80 [9] years; 53% women) mean (SD) left ventricular ejection fraction was 47% (16%) and mean (SD) eGFR was 53 (29) mL\/min per 1.73 m<jats:sup>2<\/jats:sup>; 54\u202f010 (63%) had an eGFR less than 60 mL\/min per 1.73 m<jats:sup>2<\/jats:sup>. By 1 year after HF hospitalization, 6% had progressed to dialysis, 7% had progressed to dialysis or end-stage kidney disease, and 7% had been readmitted for AKI. Incident dialysis increased steeply with lower discharge eGFR category: compared with patients with an eGFR of 60 mL\/min per 1.73 m<jats:sup>2<\/jats:sup> or more, individuals with an eGFR of 45 to less than 60 and of less than 30 mL\/min per 1.73 m<jats:sup>2<\/jats:sup> had higher rates of dialysis readmission (45 to &amp;amp;lt;60: adjusted hazard ratio [AHR], 2.16 [95% CI, 1.86-2.51]; &amp;amp;lt;30: AHR, 28.46 [95% CI, 25.25-32.08]). Lower discharge eGFR (per 10 mL\/min per 1.73 m<jats:sup>2<\/jats:sup> decrease) was independently associated with a higher rate of readmission for dialysis (AHR, 2.23; 95% CI, 2.14-2.32), dialysis or end-stage kidney disease (AHR, 2.34; 95% CI, 2.24-2.44), and AKI (AHR, 1.25; 95% CI, 1.23-1.27), with similar findings for all-cause mortality, all-cause readmission, and HF readmission. Baseline left ventricular ejection fraction did not modify the covariate-adjusted association between lower discharge eGFR and kidney outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr240004-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, older adults with HF had substantial risk of kidney complications, with an estimated 6% progressing to dialysis in the year after HF hospitalization. These findings emphasize the need for health care approaches prioritizing kidney health in this high-risk population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2024.1108","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:13Z","timestamp":1716994873000},"page":"667","source":"Crossref","is-referenced-by-count":6,"title":["Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure"],"prefix":"10.1001","volume":"9","author":[{"given":"John W.","family":"Ostrominski","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole C.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Chiswell","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam D.","family":"DeVore","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"Department of Medicine, University of Mississippi Medical Center, Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna C.","family":"Huang","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M.","family":"Kittleson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen E.","family":"Joynt Maddox","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik K.","family":"Linganathan","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"McDermott","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali Tiku","family":"Owens","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela N.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Denver Health Medical Center, Denver, Colorado"},{"name":"Department of Medicine, Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly","family":"Vardeny","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"7","key":"hbr240004r1","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/eurheartj\/eht386","article-title":"Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis.","volume":"35","author":"Damman","year":"2014","journal-title":"Eur Heart J"},{"issue":"3","key":"hbr240004r2","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1161\/CIRCULATIONAHA.120.047019","article-title":"Temporal trends in prevalence and prognostic implications of comorbidities among patients with acute decompensated heart failure: the ARIC Study Community Surveillance.","volume":"142","author":"Pandey","year":"2020","journal-title":"Circulation"},{"issue":"4","key":"hbr240004r3","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.jacc.2021.05.002","article-title":"Kidney function and outcomes in patients hospitalized with heart failure.","volume":"78","author":"Patel","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"14","key":"hbr240004r4","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1093\/eurheartj\/ehab832","article-title":"Kidney function assessment and endpoint ascertainment in clinical trials.","volume":"43","author":"Khan","year":"2022","journal-title":"Eur Heart J"},{"issue":"4","key":"hbr240004r5","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/01.hpc.0000243588.00012.79","article-title":"Overview of the American Heart Association \u201cGet With The Guidelines\u201d programs: coronary heart disease, stroke, and heart failure.","volume":"5","author":"Hong","year":"2006","journal-title":"Crit Pathw Cardiol"},{"issue":"19","key":"hbr240004r6","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C\u2013based equations to estimate GFR without race.","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"issue":"9","key":"hbr240004r7","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1161\/CIRCULATIONAHA.120.049514","article-title":"Challenges of cardio-kidney composite outcomes in large-scale clinical trials.","volume":"143","author":"Patel","year":"2021","journal-title":"Circulation"},{"issue":"4","key":"hbr240004r8","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jacc.2018.04.070","article-title":"Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF Registry.","volume":"72","author":"Greene","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"hbr240004r9","doi-asserted-by":"publisher","first-page":"e1008","DOI":"10.1016\/S2214-109X(18)30306-1","article-title":"Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study.","volume":"6","author":"Teng","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"9","key":"hbr240004r10","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1002\/ejhf.v23.9","article-title":"Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UK and Sweden).","volume":"23","author":"Savarese","year":"2021","journal-title":"Eur J Heart Fail"},{"issue":"6","key":"hbr240004r11","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.jchf.2018.02.004","article-title":"Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure.","volume":"6","author":"Damman","year":"2018","journal-title":"JACC Heart Fail"},{"issue":"13","key":"hbr240004r12","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1161\/CIRCULATIONAHA.120.047643","article-title":"Angiotensin-neprilysin inhibition and renal outcomes in heart failure with preserved ejection fraction.","volume":"142","author":"Mc Causland","year":"2020","journal-title":"Circulation"},{"issue":"1","key":"hbr240004r13","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1001\/jamacardio.2022.4210","article-title":"Dapagliflozin and kidney outcomes in patients with heart failure with mildly reduced or preserved ejection fraction: a prespecified analysis of the DELIVER randomized clinical trial.","volume":"8","author":"Mc Causland","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"31","key":"hbr240004r14","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1093\/eurheartj\/ehad344","article-title":"Sacubitril\/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF.","volume":"44","author":"Vaduganathan","year":"2023","journal-title":"Eur Heart J"},{"issue":"10365","key":"hbr240004r15","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.1016\/S0140-6736(22)02074-8","article-title":"Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials.","volume":"400","author":"Nuffield Department of Population Health Renal Studies Group","year":"2022","journal-title":"Lancet"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2819215\/jamacardiology_ostrominski_2024_br_240004_1719329896.90158.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T15:05:36Z","timestamp":1720623936000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2819215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":15,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2024.1108","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}