CONGESTIVE-HEART-FAILURE IN DIALYSIS PATIENTS - PREVALENCE, INCIDENCE, PROGNOSIS AND RISK-FACTORS

Cardiovascular disease is the most common cause of death in dialysis s ubjects. Congestive heart failure (CHF) is a common presenting symptom of cardiovascular disease in the dialysis population. Information reg arding prevalence, incidence, risk factors and prognosis is crucial fo r planning rational interventional studies. A prospective multicenter cohort study of 432 dialysis patients followed for a mean of 41 months was carried out. Prospective information on a variety of risk factors was collected. Annual echocardiography and clinical assessment was pe rformed. Major endpoints included death and the development of morbid cardiovascular events. One hundred and thirty-three (31%) subjects had CHF at the time of initiation of dialysis therapy. Multivariate analy sis showed that the following risk factors were significantly and inde pendently associated with CHF at baseline: systolic dysfunction, older age, diabetes mellitus and ischemic heart disease. Seventy-six of 299 subjects (25%) who did not have baseline CHF subsequently developed C HF during their course on dialysis. Compared to those subjects who nev er developed CHF (N = 218) multivariate analysis identified the follow ing risk factors for the development of CHF: older age, anemia during dialysis therapy, hypoalbuminemia, hypertension during dialysis therap y, and systolic dysfunction. Seventy-five of the 133 (56%) subjects wi th CHF at baseline had recurrent CHF during follow-up. Independent and significant risk factors for CHF recurrence were ischemic heart disea se and systolic dysfunction, anemia during dialysis therapy and hypoal buminemia. The median survival of subjects with CHF at baseline was 36 months compared to 62 months in subjects without CHF. In this study t he prevalence of CHF on starting ESRD therapy and the subsequent annua l incidence was high. CHF was a strong, independent, adverse prognosti c indicator. Risk factors for CHF include older age, pre-existing card iac diseases (systolic dysfunction and ischemic heart disease), and po tentially reversible abnormalities related to chronic uremia (anemia, hypertension and hypoalbuminemia).