McClellan William M, Langston Robert D, Presley Rodney
Georgia Medical Care Foundation, Atlanta, Georgia 30346, USA.
J Am Soc Nephrol. 2004 Jul;15(7):1912-9. doi: 10.1097/01.asn.0000129982.10611.4c.
The risk of progression to ESRD among individuals with cardiovascular disease and chronic kidney disease (CKD) is not well defined. The purpose of this study was to describe the risk of ESRD among patients with cardiovascular disease. Charts were abstracted for randomly selected hospitalized Medicare beneficiaries with a diagnosis of either congestive heart failure (CHF) or acute myocardial infarction (AMI). The prevalence of CKD, based on the estimated modified diet in renal disease GFR of <60 ml/min per m2, was 60.4% of CHF patients and 51.7% of AMI patients. When compared with patients without CKD, the 30-d readmission rate was higher for CHF patients with CKD (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.18 to 2.44) and for AMI patients with CKD (OR, 1.78; 95% CI, 1.17 to 2.70). CHF patients (OR, 1.62; 95% CI, 1.15 to 2.30) and AMI patients (OR, 3.10; 95% CI, 1.98 to 4.84) with CKD were more likely to die during the year after discharge from the hospital. ESRD after discharge occurred in nine of 517 patients with AMI and 24 of 640 patients with CHF. CKD increased the risk of ESRD among CHF patients (OR, 34.5; 95% CI, 4.23 to 279.43) and AMI patients (0 and 3% for those without and with CKD, respectively). At discharge, 18% of AMI patients and 21% of CHF patients with CKD were discharged with a diagnosis of renal disease. CKD is highly prevalent among patients with cardiovascular disease and is associated with increased risk of adverse outcomes, including progression to ESRD. This study suggests that opportunities may exist to improve the detection of CKD in these patients who are hospitalized with cardiovascular disease.
心血管疾病和慢性肾脏病（CKD）患者进展为终末期肾病（ESRD）的风险尚不明确。本研究的目的是描述心血管疾病患者发生ESRD的风险。对随机选取的诊断为充血性心力衰竭（CHF）或急性心肌梗死（AMI）的住院医疗保险受益人病历进行了摘要分析。根据估计的肾脏病改良饮食公式计算的肾小球滤过率（GFR）<60 ml/（min·m²），CKD在CHF患者中的患病率为60.4%，在AMI患者中为51.7%。与无CKD的患者相比，有CKD的CHF患者30天再入院率更高（比值比[OR]，1.70；95%置信区间[CI]，1.18至2.44），有CKD的AMI患者也是如此（OR，1.78；95%CI，1.17至2.70）。有CKD的CHF患者（OR，1.62；95%CI，1.15至2.30）和AMI患者（OR，3.10；95%CI，1.98至4.84）在出院后一年内死亡的可能性更大。出院后，517例AMI患者中有9例发生ESRD，640例CHF患者中有24例发生ESRD。CKD增加了CHF患者发生ESRD的风险（OR，34.5；95%CI，4.23至279.43）以及AMI患者发生ESRD的风险（无CKD者为0，有CKD者为3%）。出院时，18%的有CKD的AMI患者和21%的有CKD的CHF患者出院诊断为肾病。CKD在心血管疾病患者中非常普遍，并且与不良结局风险增加相关，包括进展为ESRD。本研究表明，对于这些因心血管疾病住院的患者，可能存在改善CKD检测的机会。
