Kidney International Reports · Jul 4, 2026

10-Year Trends in Heart Failure Among Patients With Dialysis and Nondialysis CKD

By Lankinen R, Murata S, Carrero JJ et al.

INTRODUCTION: This study explores the rates and temporal trends of heart failure (HF) in advanced chronic kidney disease (CKD) compared with the general population (GP). METHODS: We included all patients with nondialysis dependent CKD stage G4 (n = 25,591) and G5 (n = 13,968), on hemodialysis (HD; n = 10,635) and peritoneal dialysis (PD; n = 4511) enrolled in the Swedish Renal Registry during 2011 and 2021. Outcomes included HF-related hospitalization and HF-related mortality. Patients were followed until the event, death, or progression to a more severe CKD-stage and/or change of dialysis modality. Poisson models were used to estimate unadjusted incidence rates (IR) and IR standardized to an age- sex-matched GP. RESULTS: Rates of HF-related hospitalization increased with more advanced stages of CKD, ranging from 3.7 to 6.8 times higher than those in the GP. Between 2011 and 2021, renin-angiotensin system inhibitor (RASi) and beta-blocker use remained stable and relatively low (44.5% to 70% for RASi), whereas diuretic prescription declined in nondialysis (ND)-CKD. This paralleled an important increase in the rates of HF-related hospitalization in CKD stage 4 (+51%), 5-ND (+36%), and HD (+30%), with a larger increase than that observed in the GP. In contrast, HF-related mortality steadily declined in both ND-CKD (up to -20.8% in CKD stage 4) and dialysis dependent CKD (up to -66% in HD), although slower than in the GP. CONCLUSION: Despite decline in HF-related mortality over the past decade-although slower than in the GP-HF-related hospitalization rates have risen substantially in advanced CKD, with a faster increase than those in the GP. These findings highlight the growing HF burden in CKD, and the need for targeted prevention and management strategies.

doi.org/10.1016/j.ekir.2026.106695Open accessPubMed 42577027Populations