Amsalem Yoram, Garty Moshe, Schwartz Roseline, Sandach Amir, Behar Solomon, Caspi Abraham, Gottlieb Shmuel, Ezra David, Lewis Basil S, Leor Jonathan
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel.
Eur Heart J. 2008 Apr;29(8):1029-36. doi: 10.1093/eurheartj/ehn102. Epub 2008 Mar 12.
Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF.
We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08.
A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.
肾功能不全（RI）是心力衰竭（HF）患者不良预后的有力预测指标。我们旨在确定未被识别的RI的患病率及其在因HF住院患者中的意义。
我们分析了对4102例因HF住院患者进行的前瞻性调查数据。2145例（57%）患者存在RI[定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²]，但根据病历记录，其中872例[41%，95%置信区间（CI）39 - 43%]未被识别。与已识别RI的患者相比，未被识别RI的患者更可能为女性、老年人且心功能分级更好。与无RI的患者相比，已识别和未被识别RI的患者住院期间及1年死亡率显著更高：分别为6.5%和7.1% vs. 2.1%，以及38.8%和30.9% vs. 18.8%（P<0.001）。调整后，已识别和未被识别的RI对住院死亡率增加的预测相当：比值比（OR）及95%CI分别为2.34（1.43 - 3.87），P<0.001，以及2.30（1.45 - 3.72），P<0.001。1年后，已识别的RI仍然是死亡率的独立预测指标：OR 1.79（1.45 - 2.20），P<0.001，而未被识别的RI有增加死亡率的趋势：OR 1.22（0.97 - 1.53），P = 0.08。
在因HF住院的患者中，很大一部分RI未被识别。由于合并RI具有重要的预后和治疗意义，HF患者可能受益于常规的肾小球滤过率评估。
