Abstract
BACKGROUND: Heart failure (HF) is a frequent and clinically relevant comorbidity in patients with chronic kidney disease (CKD). Both conditions are closely linked through hemodynamic, neurohormonal, and inflammatory mechanisms, resulting in excess morbidity and mortality. However, nationwide epidemiological data for hospitalized patients with CKD in Germany are scarce. This study aimed to determine the prevalence and outcomes of HF in CKD using a large real-world dataset. MATERIALS AND METHODS: We conducted a retrospective, observational study analyzing administrative data from 87 German hospitals between 2016 and 2022 (n = 48,011 CKD index cases). Patients were stratified into CKD with HF (n = 22,085; 46%) and CKD without HF (n = 25,926; 54%). Additional electronic medical records (EMR) from 23,377 CKD patients of the Heart Center Leipzig were included. All hospital readmissions were considered during the follow-up period. Comparative statistics are presented for each group. RESULTS: CKD patients with HF were older (76.5 ± 10.8 vs. 71.5 ± 14.3 years, p < 0.001), more frequently affected by cardiovascular and metabolic comorbidities, and had worse renal function. In-hospital mortality was higher in CKD-HF than CKD-no-HF patients (16.5% vs. 6.7%; odds ratio [OR] 2.73, 95% CI 2.58-2.89; p < 0.001). During follow-up, readmissions occurred earlier (175 ± 266 vs. 212 ± 309 days, p < 0.001) and more frequently in the CKD-HF group (20.3 vs. 17.7 events per 100 patient-years). Follow-up in-hospital mortality was also increased in CKD-HF patients (13.3% vs. 8.7%; OR 1.62, 95% CI 1.52-1.73; p < 0.001). DISCUSSION: In this large, multicenter, real-world cohort, HF was highly prevalent in CKD and associated with substantially increased morbidity and mortality. These findings highlight the considerable public health burden of HF in CKD and the urgent need for targeted prevention and management strategies.