Chronic kidney disease associated mortality in diastolic versus systolic heart failure: A propensity matched study
Chronic kidney disease associated mortality in diastolic versus systolic heart failure: A propensity matched study
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DOI：
10.1016/j.amjcard.2006.08.042
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发表时间：
2007-02-01
影响因子：
2.8
通讯作者：
Shlipak, Michael G.
中科院分区：
文献类型：
--
作者：
Ahmed, Ali;Rich, Michael W.;Shlipak, Michael G.
慢性肾脏病(CKD)很常见，并与心力衰竭(HF)死亡率增加有关。然而，目前尚不清楚慢性肾脏病对死亡率的影响是否因左心室射血分数(LVEF)而异。我们评估了慢性KD对收缩期心衰(LVEF 45%)患者死亡率的影响。在洋地黄调查组试验的7788名患者中，3527名(45%)患有CKD(估计肾小球滤过率<；60ml/min/1.73m(2))。我们使用多变量Logistic回归模型(c统计量0.76，赛后绝对标准化差异，所有32个协变量的5%)计算每个患者的CKD倾向评分。我们匹配了2399对有CKD和没有CKD的患者，他们的倾向评分相似。在没有慢性肾脏病和有慢性肾脏病的患者中，分别有757例(1,049/10,000人年)和882例(1,282/10,000人年)死亡(危险比1.22，95%可信区间1.09-1.36，p<；0.0001)。与慢性肾脏病相关的死亡率，舒张期心力衰竭患者(371例额外死亡/10,000人年，危险比1.71，95%可信区间1.21-2.41，p=0.002)高于收缩期心力衰竭患者(214例额外死亡/10,000人年，危险比1.19，95%可信区间1.07-1.32，p=0.001)，差异有统计学意义(交互作用调整p=0.034)。CKD相关死亡与左心室射血分数之间存在分级关联。左心室射血分数为35%、35%至55%和55%的亚组CKD相关死亡的风险比分别为1.15(95%可信区间1.02至1.29)、1.35(95%可信区间1.11至1.64)和2.33(95%可信区间1.34至4.06)。总之，舒张期心力衰竭患者的慢性肾脏病相关死亡率高于收缩期心衰患者。舒张性心衰患者应评估是否有慢性肾脏病，肾素-血管紧张素系统抑制剂在这些患者中的作用需要研究。(C)2007 Elsevier Inc.保留所有权利。
Chronic kidney disease (CKD) is common and is associated with increased mortality in heart failure (HF). However, it is unknown whether the effect of CKD on mortality varies by left ventricular ejection fraction (LVEF). We evaluated the effect of CKD on mortality in patients with systolic (LVEF 45%) HF. Of the 7,788 patients in the Digitalis Investigation Group trial, 3,527 (45%) had CKD (estimated glomerular filtration rate < 60 ml/min/1.73 m(2)). We calculated the propensity score for CKD for each patient, using a multivariate logistic regression model (c statistic 0.76, postmatch absolute standardized differences < 5% for all 32 co-variates). We matched 2,399 pairs of patients with and without CKD with similar propensity scores. There were 757 (rate 1,049/10,000 person-years) and 882 (rate 1,282/10,000 person-years) deaths, respectively, in patients without and with CKD (hazard ratio 1.22, 95% confidence interval 1.09 to 1.36, p < 0.0001). CKD-associated mortality was higher in those with diastolic HF (371 extra deaths/10,000 person-years, hazard ratio 1.71, 95% confidence interval 1.21 to 2.41, p = 0.002) than in systolic HF (214 extra deaths/10,000 person-years, hazard ratio 1.19, 95% confidence interval 1.07 to 1.32, p = 0.001), which was significant (adjusted p for interaction = 0.034). A graded association was found between CKD-related deaths and LVEF. The hazard ratios for CKD-associated mortality for the LVEF subgroups of < 35%, 35% to 55%, and > 55% were 1.15 (95% confidence interval 1.02 to 1.29), 1.35 (95% confidence interval 1.11 to 1.64), and 2.33 (95% confidence interval 1.34 to 4.06). In conclusion, CKD-associated mortality was higher in those with diastolic than systolic HF. Patients with diastolic HF should be evaluated for CKD, and the role of inhibitors of the renin-angiotensin system in these patients needs to be investigated. (c) 2007 Elsevier Inc. All rights reserved.