Reduced kidney function as a risk factor for incident heart failure: The Atherosclerosis Risk in Communities (ARIC) study
Reduced kidney function as a risk factor for incident heart failure: The Atherosclerosis Risk in Communities (ARIC) study
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DOI：
10.1681/asn.2006101159
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发表时间：
2007-04-01
影响因子：
13.6
通讯作者：
Coresh, Josef
中科院分区：
文献类型：
--
作者：
Kottgen, Anna;Russell, Stuart D.;Coresh, Josef
肾脏功能降低是心血管发病率和死亡率的危险因素，心力衰竭（HF）和肾衰竭的发生率都在增加。因此，这项研究试图确定肾功能降低对中年成年人的基于人群的研究的影响。从1987年到2002年，遵循HF住院或死亡事件（国际疾病分类，第九修订/第10修订版本428/150），遵循基线时没有普遍的HF的社区动脉粥样硬化风险（ARIC）的14,857名参与者。估计的GFR（EGFR）是使用肾脏疾病（MDRD）研究方程的缩写修饰（MDRD）的缩写，肾功能分为正常（EGFR> = 90 ml/min每1.73 m（2）； n = 7143）减少（EGFR 60至89 ml/min每1.73 in 2 in 2; n = 7311），并且中度/严重减少（EGFR） <60 mL/min每1.73 m（2）; n = 403）。 COX比例危害模型用于控制人口统计和心血管危险因素。通过基线时存在冠心病的存在对分析进行了分层。在13.2年的平均随访期间，1193名参与者发展了HF。与具有EGFR的参考组相比，EGFR <60 ml/min的个体的HF发生率高三倍，每1.73 m（2）每1.73 m（2）（2）（每1000人为6）年）。与参考组相比，EGFR <60 mL/min的患者每1.73 m（2）的患者的总体调整性相对危害为1.94（1.49至2.53），基线时患有和没有普遍性冠心病的个体显着增加。与未发展HF的人相比，与HF住院/死亡同时，肾功能的下降大大下降了。总而言之，中年成年人中等/严重降低肾脏功能的HF有高风险。
Reduced kidney function is a risk factor for cardiovascular morbidity and mortality, and both heart failure (HF) and kidney failure incidences are increasing. This study therefore sought to determine the effect of decreased kidney function on HF incidence in a population-based study of middle-aged adults. From 1987 through 2002, 14,857 participants of the Atherosclerosis Risk in Communities (ARIC) study who were free of prevalent HF at baseline were followed for incident HF hospitalization or death (International Classification of Diseases, Ninth Revision/10th Revision 428/150). Estimated GFR (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease (MDRD) Study equation, and kidney function was categorized as normal (eGFR >= 90 ml/min per 1.73 m(2); n = 7143), mildly reduced (eGFR 60 to 89 ml/min per 1.73 In 2; n = 7311), and moderately/severely reduced (eGFR < 60 ml/min per 1.73 m(2); n = 403). Cox proportional hazards models were used to control for demographic and cardiovascular risk factors; analyses were stratified by the presence of coronary heart disease at baseline. During a mean follow-up of 13.2 yr, 1193 participants developed HF. The incidence of HF was three-fold higher for individuals with eGFR < 60 ml/min per 1.73 m(2) compared to the reference group with eGFR :90 ml/min per 1.73 m(2) (18 versus 6 per 1000 person-years). The overall adjusted relative hazard of developing HF was 1.94 (1.49 to 2.53) for individuals with eGFR < 60 ml/min per 1.73 m(2) compared to the reference group and was significantly increased for individuals with and without prevalent coronary heart disease at baseline. A substantially greater decline in kidney function occurred in individuals concomitant with HF hospitalization/death compared to those who did not develop HF. In summary, middle-aged adults with moderately/severely reduced kidney function are at high risk for developing HF.