Proteinuria, Chronic Kidney Disease, and the Effect of an Angiotensin Receptor Blocker in Addition to an Angiotensin-Converting Enzyme Inhibitor in Patients With Moderate to Severe Heart Failure
Proteinuria, Chronic Kidney Disease, and the Effect of an Angiotensin Receptor Blocker in Addition to an Angiotensin-Converting Enzyme Inhibitor in Patients With Moderate to Severe Heart Failure
复制标题
DOI：
10.1161/circulationaha.109.853648
复制
发表时间：
2009-10-20
期刊：
影响因子：
37.8
通讯作者：
Cohn, Jay N.
中科院分区：
文献类型：
--
作者：
Anand, Inder S.;Bishu, Kalkidan;Cohn, Jay N.
背景-慢性肾脏病（CKD）是心力衰竭（HF）预后不良的既定危险因素。蛋白尿是否提供额外的预后信息尚不清楚。肾素-血管紧张素阻滞药物改善结果在HF，但在HF患者的肾功能不全，因为安全性问题和缺乏证据证明其effectiveness.Methods和Results-In缬沙坦在心力衰竭试验（Val-HeFT），5010例患者与II级，III级或IV级心力衰竭被随机分配到接受缬沙坦或安慰剂。2个主要结局是死亡和首次发病事件，定义为死亡、猝死伴复苏、因HF住院或静脉注射正性肌力药物或血管扩张药物4小时或以上而未住院。研究队列根据CKD的存在分为亚组（估计肾小球滤过率
Background-Chronic kidney disease (CKD) is an established risk factor for poor outcomes in heart failure (HF). Whether proteinuria provides additional prognostic information is not known. Renin-angiotensin blockade medications improve outcomes in HF but are underutilized in HF patients with renal dysfunction because of safety concerns and a lack of evidence of their effectiveness.Methods and Results-In the Valsartan in Heart Failure Trial (Val-HeFT), 5010 patients with class II, III, or IV heart failure were randomly assigned to receive valsartan or placebo. The 2 primary outcomes were death and first morbid event, defined as death, sudden death with resuscitation, hospitalization for HF, or administration of intravenous inotropic or vasodilator drugs for 4 hours or more without hospitalization. The study cohort was divided into subgroups according to the presence of CKD (estimated glomerular filtration rate