Smith Grace L, Lichtman Judith H, Bracken Michael B, Shlipak Michael G, Phillips Christopher O, DiCapua Paul, Krumholz Harlan M
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Am Coll Cardiol. 2006 May 16;47(10):1987-96. doi: 10.1016/j.jacc.2005.11.084. Epub 2006 Apr 24.
We estimated the prevalence of renal impairment in heart failure (HF) patients and the magnitude of associated mortality risk using a systematic review of published studies.
Renal impairment in HF patients is associated with excess mortality, although precise risk estimates are unclear.
A systematic search of MEDLINE (through May 2005) identified 16 studies characterizing the association between renal impairment and mortality in 80,098 hospitalized and non-hospitalized HF patients. All-cause mortality risks associated with any renal impairment (creatinine >1.0 mg/dl, creatinine clearance [CrCl] or estimated glomerular filtration rate [eGFR] <90 ml/min, or cystatin-C >1.03 mg/dl) and moderate to severe impairment (creatinine > or =1.5, CrCl or eGFR <53, or cystatin-C > or =1.56) were estimated using fixed-effects meta-analysis.
A total of 63% of patients had any renal impairment, and 29% had moderate to severe impairment. After follow-up > or =1 year, 38% of patients with any renal impairment and 51% with moderate to severe impairment died versus 24% without impairment. Adjusted all-cause mortality was increased for patients with any impairment (hazard ratio [HR] = 1.56; 95% confidence interval [CI] 1.53 to 1.60, p < 0.001) and moderate to severe impairment (HR = 2.31; 95% CI 2.18 to 2.44, p < 0.001). Mortality worsened incrementally across the range of renal function, with 15% (95% CI 14% to 17%) increased risk for every 0.5 mg/dl increase in creatinine and 7% (95% CI 4% to 10%) increased risk for every 10 ml/min decrease in eGFR.
Renal impairment is common among HF patients and confers excess mortality. Renal function should be considered in risk stratification and evaluation of therapeutic strategies for HF patients.
我们通过对已发表研究的系统评价，估计心力衰竭（HF）患者肾功能损害的患病率以及相关死亡风险的程度。
HF患者的肾功能损害与额外的死亡率相关，尽管精确的风险估计尚不清楚。
对MEDLINE（截至2005年5月）进行系统检索，确定了16项研究，这些研究描述了80098例住院和非住院HF患者肾功能损害与死亡率之间的关联。使用固定效应荟萃分析估计与任何肾功能损害（肌酐>1.0mg/dl、肌酐清除率[CrCl]或估计肾小球滤过率[eGFR]<90ml/min，或胱抑素-C>1.03mg/dl）以及中度至重度损害（肌酐>或=1.5、CrCl或eGFR<53，或胱抑素-C>或=1.56）相关的全因死亡风险。
共有63%的患者存在任何肾功能损害，29%的患者存在中度至重度损害。随访≥1年后，任何肾功能损害患者中有38%死亡，中度至重度损害患者中有51%死亡，而无肾功能损害患者中这一比例为24%。任何肾功能损害患者的校正全因死亡率增加（风险比[HR]=1.56；95%置信区间[CI]1.53至1.60，p<0.001），中度至重度损害患者的校正全因死亡率增加（HR=2.31；95%CI2.18至2.44，p<0.001）。在整个肾功能范围内，死亡率逐渐恶化，肌酐每增加0.5mg/dl，风险增加15%（95%CI14%至17%），eGFR每降低10ml/min，风险增加7%（95%CI4%至10%）。
肾功能损害在HF患者中很常见，并导致额外的死亡率。在对HF患者进行风险分层和评估治疗策略时应考虑肾功能。
