{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:08Z","timestamp":1786480208799,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U2CDK140919"],"award-info":[{"award-number":["U2CDK140919"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["TL1DK143270"],"award-info":[{"award-number":["TL1DK143270"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["K26DK138333"],"award-info":[{"award-number":["K26DK138333"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U2CDK140919"],"award-info":[{"award-number":["U2CDK140919"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["TL1DK143270"],"award-info":[{"award-number":["TL1DK143270"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["K26DK138333"],"award-info":[{"award-number":["K26DK138333"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,5]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Patients treated with dialysis have a high burden of heart failure symptoms and functional limitations.<\/jats:p>\n <\/jats:list-item>\n \n Higher burden of heart failure symptoms are associated with higher rates of subsequent heart failure hospitalizations.<\/jats:p>\n <\/jats:list-item>\n \n Higher burden of symptoms are associated with higher risk of death.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Diagnosing heart failure (HF) in dialysis patients is challenging because of overlapping symptoms of volume overload. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status questionnaire measuring HF symptoms and functional limitations, with lower scores indicating greater burden.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We studied 625 Chronic Renal Insufficiency Cohort study participants who developed ESKD and had KCCQ scores post-ESKD diagnosis treated with hemodialysis or peritoneal dialysis. The primary outcomes were rates of HF hospitalization, 30-day HF readmission, and all-cause mortality. KCCQ was modeled dichotomously (<75 versus \u226575) and continuously (per five-point decrement). Poisson regression with robust standard errors was used to test the association of KCCQ score with each outcome.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 625 participants (mean age 59 years; 60% male; 87% on hemodialysis), median follow-up from KCCQ evaluation was 6.8 (interquartile range, 3.2\u201312.0) years. Those with KCCQ <75 had nearly twice the rate of HF hospitalizations (15.4 versus 8.4\/100 person-years) compared with KCCQ \u226575. Each five-point decrement in KCCQ was associated with 9% higher adjusted relative risk (aRR) of HF hospitalization (\n P<\/jats:italic>\n = 0.0003), 7% higher aRR of 30-day HF readmission (\n P<\/jats:italic>\n = 0.03), and 6% higher aRR of all-cause mortality (\n P<\/jats:italic>\n < 0.001). Stratified by HF subtype, patients with HF with reduced ejection fraction and KCCQ <75 had 81% higher aRR of HF hospitalization versus those with KCCQ \u226575 (\n P<\/jats:italic>\n = 0.02). Decline in KCCQ by \u22655 from pre-ESKD to post-ESKD was associated with >40% increase in aRR of all-cause mortality (\n P<\/jats:italic>\n = 0.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Higher HF symptom burden and functional limitations at dialysis initiation are independently associated with increased risk of HF hospitalization and all-cause mortality, suggesting that the KCCQ score may help predict outcomes early in the course of treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001142","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T17:00:13Z","timestamp":1768323613000},"page":"1034-1045","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Association of Early Heart Failure Symptoms and Subsequent Heart Failure Hospitalizations and Mortality among Dialysis Patients"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1893-9183","authenticated-orcid":false,"given":"Mahlet","family":"Assefa","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8461-5111","authenticated-orcid":false,"given":"Leila R.","family":"Zelnick","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"},{"name":"Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Kestenbaum","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"},{"name":"Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9583-8628","authenticated-orcid":false,"given":"Nisha","family":"Bansal","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"},{"name":"Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"issue":"10","key":"B1-20260601","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","article-title":"Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America","volume":"29","author":"Bozkurt","year":"2023","journal-title":"J Card Fail."},{"issue":"6","key":"B3-20260601","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0272-6386(03)00359-7","article-title":"Heart failure as a cause for hospitalization in chronic dialysis patients","volume":"41","author":"Trespalacios","year":"2003","journal-title":"Am J Kidney Dis."},{"issue":"23","key":"B4-20260601","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1136\/heartjnl-2016-310794","article-title":"Heart failure in patients with kidney disease","volume":"103","author":"Tuegel","year":"2017","journal-title":"Heart."},{"issue":"2","key":"B5-20260601","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2215\/CJN.04910514","article-title":"NT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults","volume":"10","author":"Bansal","year":"2015","journal-title":"Clin J Am Soc Nephrol."},{"issue":"1","key":"B6-20260601","first-page":"1","article-title":"Cardiac biomarkers in dialysis","volume":"4","author":"Mahmood","year":"2017","journal-title":"AIMS Genet."},{"issue":"5","key":"B7-20260601","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0735-1097(00)00531-3","article-title":"Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure","volume":"35","author":"Green","year":"2000","journal-title":"J Am Coll Cardiol."},{"issue":"20","key":"B8-20260601","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1016\/j.jacc.2020.09.542","article-title":"Interpreting the Kansas City Cardiomyopathy Questionnaire in clinical trials and clinical care: JACC state-of-the-art review","volume":"76","author":"Spertus","year":"2020","journal-title":"J Am Coll Cardiol."},{"issue":"2","key":"B9-20260601","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/ejhf.2139","article-title":"Current challenges for using the Kansas City Cardiomyopathy Questionnaire to obtain a standardized patient-reported health status outcome","volume":"23","author":"Stogios","year":"2021","journal-title":"Eur J Heart Fail."},{"issue":"4","key":"B10-20260601","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1161\/CIRCHEARTFAILURE.115.002097","article-title":"Kansas City Cardiomyopathy Questionnaire score is associated with incident heart failure hospitalization in patients with chronic kidney disease without previously diagnosed heart failure: Chronic Renal Insufficiency Cohort study","volume":"8","author":"Mishra","year":"2015","journal-title":"Circ Heart Fail."},{"issue":"7 suppl 2","key":"B11-20260601","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1097\/01.ASN.0000070149.78399.CE","article-title":"The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods","volume":"14","author":"Feldman","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"8","key":"B12-20260601","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.2215\/CJN.00070109","article-title":"Chronic Renal Insufficiency Cohort (CRIC) study: baseline characteristics and associations with kidney function","volume":"4","author":"Lash","year":"2009","journal-title":"Clin J Am Soc Nephrol."},{"issue":"1","key":"B14-20260601","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1001\/jamacardio.2024.4470","article-title":"Interpreting population mean treatment effects in the Kansas City Cardiomyopathy Questionnaire: a patient-level meta-analysis","volume":"10","author":"Abdel Jawad","year":"2025","journal-title":"JAMA Cardiol."},{"issue":"21","key":"B15-20260601","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1016\/j.jacc.2019.02.071","article-title":"Burden and outcomes of heart failure hospitalizations in adults with chronic kidney disease","volume":"73","author":"Bansal","year":"2019","journal-title":"J Am Coll Cardiol."},{"issue":"1","key":"B16-20260601","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1161\/01.CIR.88.1.107","article-title":"Survival after the onset of congestive heart failure in Framingham heart study subjects","volume":"88","author":"Ho","year":"1993","journal-title":"Circulation."},{"issue":"3","key":"B17-20260601","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2215\/CJN.06020612","article-title":"A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study","volume":"8","author":"Bansal","year":"2013","journal-title":"Clin J Am Soc Nephrol."},{"issue":"3","key":"B18-20260601","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1053\/j.ajkd.2018.02.363","article-title":"Evolution of echocardiographic measures of cardiac disease from CKD to ESRD and risk of all-cause mortality: findings from the CRIC study","volume":"72","author":"Bansal","year":"2018","journal-title":"Am J Kidney Dis."},{"issue":"5","key":"B19-20260601","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1001\/jamacardio.2021.0372","article-title":"Comparison of New York Heart Association class and patient-reported outcomes for heart failure with reduced ejection fraction","volume":"6","author":"Greene","year":"2021","journal-title":"JAMA Cardiol."},{"issue":"9","key":"B20-20260601","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.jchf.2021.04.012","article-title":"Prognostic importance of health status versus functional status in heart failure and secondary mitral regurgitation","volume":"9","author":"Arnold","year":"2021","journal-title":"JACC Heart Fail."},{"issue":"1","key":"B21-20260601","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s43044-024-00532-z","article-title":"Prognostic value of quality of life and functional status in patients with heart failure: a systematic review and meta-analysis","volume":"76","author":"Ali","year":"2024","journal-title":"Egypt Heart J."},{"issue":"17","key":"B22-20260601","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J Am Coll Cardiol."},{"issue":"4","key":"B23-20260601","doi-asserted-by":"crossref","first-page":"e006134","DOI":"10.1161\/CIRCHEARTFAILURE.119.006134","article-title":"Sex differences in quality of life and clinical outcomes in patients with advanced heart failure: insights from the PAL-HF trial","volume":"13","author":"Truby","year":"2020","journal-title":"Circ Heart Fail."},{"issue":"7","key":"B24-20260601","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/j.cardfail.2022.04.008","article-title":"The impact of health care disparities on patients with heart failure","volume":"28","author":"Morris","year":"2022","journal-title":"J Card Fail."},{"issue":"5","key":"B25-20260601","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.jchf.2018.02.015","article-title":"African Americans are less likely to receive care by a cardiologist during an intensive care unit admission for heart failure","volume":"6","author":"Breathett","year":"2018","journal-title":"JACC Heart Fail."},{"issue":"9","key":"B26-20260601","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1002\/ejhf.2962","article-title":"Impact of comorbidities on health status measured using the Kansas City Cardiomyopathy Questionnaire in patients with heart failure with reduced and preserved ejection fraction","volume":"25","author":"Yang","year":"2023","journal-title":"Eur J Heart Fail."},{"issue":"12","key":"B27-20260601","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1001\/jamacardio.2017.3983","article-title":"Association of Serial Kansas City Cardiomyopathy Questionnaire assessments with death and hospitalization in patients with heart failure with preserved and reduced ejection fraction: a secondary analysis of 2 randomized clinical trials","volume":"2","author":"Pokharel","year":"2017","journal-title":"JAMA Cardiol."},{"issue":"5","key":"B28-20260601","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1053\/j.ajkd.2014.07.003","article-title":"Improving clinical outcomes among hemodialysis patients: a proposal for a \u201cvolume first\u201d approach from the chief medical officers of US dialysis providers","volume":"64","author":"Weiner","year":"2014","journal-title":"Am J Kidney Dis."},{"issue":"5","key":"B29-20260601","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1161\/CIRCOUTCOMES.115.001958","article-title":"Development and validation of a short version of the Kansas City Cardiomyopathy Questionnaire","volume":"8","author":"Spertus","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:57:45Z","timestamp":1786478265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000001142","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"2025-10-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}