Mortality, Kidney Failure, and Hospitalization Among Medicare Beneficiaries With CKD and Pulmonary Hypertension.

Abstract

RATIONALE AND OBJECTIVES\nPulmonary hypertension (PH) is highly prevalent among patients with non-dialysis dependent CKD. We studied the associations of PH with mortality, kidney failure, as well as cardiovascular (CV) and non-CV hospitalization among Medicare beneficiaries diagnosed with CKD.\n\n\nSETTING\nand Participants: Patients with PH (based on two claims within 2 years) and patients without PH matched on CKD stage from the Medicare 5% CKD sample (1996-2016).\n\n\nSTUDY DESIGN\nRetrospective, observational study using a matched cohort design PREDICTOR: Presence of pulmonary hypertension.\n\n\nOUTCOMES\nMortality, kidney failure, and all-cause, cardiovascular, and non-cardiovascular hospitalization.\n\n\nANALYTICAL APPROACH\nCox proportional hazards models to assess the association between PH and mortality, adjusting for age, sex, race, and comorbidities. Death was considered as a competing event in Fine-Gray models to assess the association between PH and kidney failure. Negative binomial model was used to evaluate the relationship between PH and all-cause, CV, and non-CV hospitalizations.\n\n\nRESULTS\n30,052 patients with PH and CKD and 150,260 CKD stage-matched patients without diagnosed PH were studied. Median age of the study population was 80.7 years, 57.8% were females, and 10.3% were African Americans. The presence of PH was associated with an increased risk of mortality after 1 (HR 2.87, 95% CI 2.79, 2.95), 2-3 (HR 1.56, 95% CI 1.51, 1.61), and 4-5 years of follow-up (HR 1.47, 95% CI 1.40, 1.53), and a higher risk of all-cause, CV, and non-CV hospitalization during the same period. PH was also associated with kidney failure in after 1 and 2-3 years but not after 4-5 years of follow-up. Patients with PH also experienced higher rates of acute kidney injury (AKI), and AKI requiring dialysis support within 30 and 90-days of AKI.\n\n\nLIMITATIONS\nReliance on billing codes and lack of echocardiogram or right heart catheterization data.\n\n\nCONCLUSIONS\nAmong older Medicare beneficiaries diagnosed with non-dialysis dependent CKD, the presence of PH was associated with an increased risk of mortality, kidney failure, and hospitalization. Understanding of these mechanism of these associations, especially the increased risk of kidney failure, requires further study.