Clinical characteristics and course of patients entering cardiac rehabilitation withchronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation(ISYDE)

Purpose: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide insight into the characteristics and clinical course of patients with chronic kidney disease (CKD) admitted to Cardiac Rehabilitation (CR) programs. Methods: Data from 165 CR units were collected online from January 28th to February 10th, 2008. Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 200 (71.312.2 yrs, 66% male) CKD patients and 2081 (66.311.6 yrs, 74% male) non-CKD patients. Compared to non-CKD, CKD patients were older and their admission diagnosis of acute myocardial infarction, myocardial revascularization or heart failure was more frequent. They also showed more cardiac and non cardiac comorbidities, mostly diabetes, chronic obstructive lung disease and cognitive impairment. During the course of CR, CKD patients had reduced access to exercise functional evaluation, more complications (particularly atrial fibrillation, worsening of chronic kidney disease and anaemia) requiring more intense medical treatment, and longer length of in-hospital stay. CKD patients were less likely discharged at home (88% versus 91%, p¼0.05), were more likely transferred to the intensive care units (8% versus 4%, p¼0.005), and had higher death rate during CR programs (2.0% versus 0.5%, p¼0.02). After adjusting for age, ejection fraction, comorbidities (acute myocardial infarction, percutaneous coronary intervention, cardiac surgery, carotid artery critical lesions, peripheral artery disease, respiratory insufficiency, heart failure, diabetes, stroke and cognitive impairment), and complications during CR program (atrial fibrillation and severe ventricular arrhythmias), multivariate logistic analysis showed that heart failure (OR 1.6, 95% CI, 1.1 to 2.4, p¼0.04), respiratory insufficiency (OR 2.4, 95% CI, 1.4 to 4.0, p¼0.0007), and cognitive impairment (OR 4.5, 95% CI, 2.5 to 8.1, p < 0.0001) were significant predictors of death during the CR program in CKD patients. Conclusions: This subanalysis of the ISYDE-2008 survey provided a detailed snapshot of the clinical characteristics, complexity and more severe clinical course of patients admitted to CR presenting with CKD.