Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study.
Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study.
复制标题
DOI：
10.1161/circoutcomes.113.000221
复制
发表时间：
2013-05-01
期刊：
影响因子：
--
通讯作者：
Go AS
中科院分区：
文献类型：
--
作者：
Smith DH;Thorp ML;Gurwitz JH;McManus DD;Goldberg RJ;Allen LA;Hsu G;Sung SH;Magid DJ;Go AS
很少有证据表明慢性肾脏疾病（CKD）对左心室射血分数（HF-PEF）保留的心力衰竭患者产生有临床意义的结果。我们确定了一个以社区为基础的HF患者队列。采用电子病历资料，根据定量和定性估计，将患者分为HF-PEF和降低的左室EF。通过估计肾小球滤过率（eGFR）和试纸蛋白尿评估CKD水平。我们对患者的死亡和住院结局（HF特异性和全因）进行了中位22.1个月的随访。多变量考克斯回归分别估计了HF-PEF和HF伴左心室EF降低的CKD水平的结局的校正相对风险。我们确定了14579例HF-PEF患者和9762例左心室EF降低的HF患者。与eGFR在60 - 89 mL/min/1.73 m2之间的患者相比，较低的eGFR与独立分级的死亡和住院风险增加相关。例如，在HF-PEF患者中，eGFR 15至29 mL/min/1.73 m2的死亡风险几乎是两倍，eGFR<15 mL/min/1.73 m2的死亡风险高出7倍，在左心室EF降低的HF患者中也有类似的发现。慢性肾脏病是一种常见病，是成人心力衰竭患者在左心室收缩功能范围内死亡和住院的重要独立预测因素。我们的研究强调了需要为越来越多的心力衰竭合并CKD患者开发新的有效干预措施。
There is scant evidence on the effect that chronic kidney disease (CKD) confers on clinically meaningful outcomes among patients with heart failure with preserved left ventricular ejection fraction (HF-PEF). We identified a community-based cohort of patients with HF. Electronic medical record data were used to divide into HF-PEF and reduced left ventricular EF on the basis of quantitative and qualitative estimates. Level of CKD was assessed by estimated glomerular filtration rate (eGFR) and by dipstick proteinuria. We followed patients for a median of 22.1 months for outcomes of death and hospitalization (HF-specific and all-cause). Multivariable Cox regression estimated the adjusted relative-risk of outcomes by level of CKD, separately for HF-PEF and HF with reduced left ventricular EF. We identified 14 579 patients with HF-PEF and 9762 with HF with reduced left ventricular EF. When compared with patients with eGFR between 60 and 89 mL/min per 1.73 m2, lower eGFR was associated with an independent graded increased risk of death and hospitalization. For example, among patients with HF-PEF, the risk of death was nearly double for eGFR 15 to 29 mL/min per 1.73 m2 and 7× higher for eGFR<15 mL/min per 1.73 m2, with similar findings in those with HF with reduced left ventricular EF. CKD is common and an important independent predictor of death and hospitalization in adults with HF across the spectrum of left ventricular systolic function. Our study highlights the need to develop new and effective interventions for the growing number of patients with HF complicated by CKD.