3 research outputs found
Temporal trends in the initiation of dialysis among patients with heart failure with or without diabetes: a nationwide study from 2002 to 2016
Background
The incidence and distribution of acute and chronic dialysis among patients with heart failure (HF), stratified by diabetes, remain uncertain. We hypothesized that with improved survival and rising comorbidities, the demand for dialysis would increase over time.
Methods and Results
Patients with incident HF, aged 18 to 100âyears, between 2002 and 2016, were identified using Danish nationwide registers. Primary outcomes included acute and chronic dialysis initiation, HFârelated hospitalization, and allâcause mortality. These outcomes were assessed in 2002 to 2006, 2007 to 2011, and 2012 to 2016, stratified by diabetes. We calculated incidence rates (IRs) per 1000 personâyears and hazard ratios (HR) using multivariable Cox regression. Of 115â533 patients with HF, 2734 patients received acute dialysis and 1193 patients received chronic dialysis. The IR was 8.0 per 1000 and 3.5 per 1000 personâyears for acute and chronic dialysis, respectively. Acute dialysis rates increased significantly among patients with diabetes over time, while no significant changes occurred in those without diabetes, chronic dialysis, HFârelated hospitalization, or overall mortality. Diabetes was associated with significantly higher HRs of acute and chronic dialysis, respectively, compared with patients without diabetes (HR, 2.07 [95% CI, 1.80â2.39] and 2.93 [95% CI, 2.40â3.58] in 2002 to 2006; HR, 2.45 [95% CI, 2.14â2.80] and 2.86 [95% CI, 2.32â3.52] in 2007 to 2011; and 2.69 [95% CI, 2.33â3.10] and 3.30 [95% CI, 2.69â4.06] in 2012 to 2016).
Conclusions
The IR of acute and chronic dialysis remained low compared with HFârelated hospitalizations and mortality. Acute dialysis rates increased significantly over time, contrasting no significant trends in other outcomes. Diabetes exhibited over 2âfold increased rates of the outcomes. These findings emphasize the importance of continued monitoring and renal care in patients with HF, especially with diabetes, to optimize outcomes and prevent adverse events