Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease
Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease
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DOI：
10.1161/circulationaha.107.734921
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发表时间：
2008-05-06
期刊：
影响因子：
37.8
通讯作者：
Gatzoulis, Michael A.
中科院分区：
文献类型：
--
作者：
Dimopoulos, Konstantinos;Diller, Gerhard-Paul;Gatzoulis, Michael A.
缺血性心脏病和获得性心力衰竭患者的肾功能不全与较高的死亡率和发病率相关。我们研究了成人先天性心脏病（ACHD）患者肾功能不全的患病率及其与outcome.Methods和结果的关系-共有1102名成人先天性心脏病患者（年龄36.0 +/- 14.2岁）参加我们的机构在1999年和2006年之间的肌酐浓度测定。肾小球滤过率（GFR）采用肾脏疾病饮食改良公式计算。患者分为正常GFR组（>= 90 mL中心点min（-1）中心点1.73 m（-2）），轻度受损GFR组（60 - 89 mL中心点min（-1）中心点1.73 m（-2））和中度/重度受损GFR组（< 60 mL中心点min（-1）中心点1.73 m（-2））。通过考克斯回归比较了GFR组之间的生存率。中位随访时间为4.1年，期间有103例患者死亡. 41%的患者肾功能不全为轻度，9%为中度或重度。GFR降低在艾森曼格生理学患者中更常见，其中72%的患者GFR降低（< 90 mL中心点min（-1）中心点1.73 m（-2），与其余患者相比P < 0.0001），18%的患者为中度或重度（P = 0.007）。肾功能不全对死亡率有实质性影响（倾向评分加权风险比3.25，95%CI 1.54至6.86，中度或重度受损与正常GFR相比P = 0.002）。结论-先天性心脏病成人患者的生理紊乱不仅限于心脏，也影响肾脏。在中度或重度GFR降低的11例患者中，死亡率是正常的3倍。
Background - Renal insufficiency in patients with ischemic heart disease and acquired heart failure is associated with higher mortality and morbidity. We studied the prevalence of renal dysfunction in adult patients with congenital heart disease ( ACHD) and its relation to outcome.Methods and Results - A total of 1102 adult patients with congenital heart disease ( age 36.0 +/- 14.2 years) attending our institution between 1999 and 2006 had creatinine concentration measured. Glomerular filtration rate ( GFR) was calculated with the Modification of Diet in Renal Disease equation. Patients were divided into groups of normal GFR ( >= 90 mL center dot min(-1) center dot 1.73 m(-2)), mildly impaired GFR ( 60 to 89 mL center dot min(-1) center dot 1.73 m(-2)), and moderately/ severely impaired GFR ( < 60 mL center dot min(-1) center dot 1.73 m(-2)). Survival was compared between GFR groups by Cox regression. Median follow- up was 4.1 years, during which 103 patients died. Renal dysfunction was mild in 41% of patients and moderate or severe in 9%. A decrease in GFR was more common among patients with Eisenmenger physiology, of whom 72% had reduced GFR ( < 90 mL center dot min(-1) center dot 1.73 m(-2), P < 0.0001 compared with the remainder), and in 18%, this was moderate or severe ( P = 0.007). Renal dysfunction had a substantial impact on mortality ( propensity score - weighted hazard ratio 3.25, 95% CI 1.54 to 6.86, P = 0.002 for moderately or severely impaired versus normal GFR).Conclusions - Deranged physiology in adult patients with congenital heart disease is not limited to the heart but also affects the kidney. Mortality is 3- fold higher than normal in the 1 in 11 patients who have moderate or severe GFR reduction.