Cardiology Department, St. Martino Hospital, Azienda Sanitaria Locale no 1, Belluno, Italy.
J Cardiovasc Med (Hagerstown). 2010 Apr;11(4):234-43. doi: 10.2459/JCM.0b013e3283334e12.
Renal dysfunction is frequently associated with heart failure and strongly influences the outcome of heart failure patients. Although recommended pharmacological interventions for heart failure may contribute to the development of, or worsen renal dysfunction, their relations with renal function have not been fully explored in an unselected community population. METHODS AND AIM: We studied 1008 patients recruited in the Italian survey on acute heart failure to assess the prevalence, the prognostic role of renal function and the relations between the changes in renal function and the pharmacological interventions during hospitalization and at 6-month follow-up. Patients were categorized using the National Kidney Foundation cut-offs for degree of renal function measured by the glomerular filtration rate.
Moderate-to-severe renal dysfunction was diagnosed in 59% of patients at hospital admission and 61% at discharge. These patients were older and had a higher prevalence of diabetes, anemia, history of hypertension, myocardial infarction and hospitalization for heart failure than those with normal or mildy impaired renal function. At admission the former were treated more frequently with diuretics, angiotensin converting enzyme-inhibitor (ACEi) or angiotensin receptor blockers (ARBs) than the latter. Diuretics were given at higher dose and for a longer time during the hospital stay while beta-blockers, digoxin, antialdosterone agents, ACEi and ARBs were given less frequently in patients who had moderate-to-severe renal dysfunction than those who did not. High-dose diuretic treatment, inability to start or maintain beta-blockers during hospital stay and the nonprescription of ACEi/ARBs at discharge emerged, by multivariate analysis, as predictors of death at 6-month follow-up (mortality rate = 14%), independent of the persistence of moderate-to-severe renal dysfunction over time, anemia, male sex and history of heart failure.
In acute heart failure, renal dysfunction is frequent and impacts prognosis. In this setting, the pharmacological interventions are significantly associated with changes in renal function and 6-month mortality.
肾功能障碍常与心力衰竭相关，并对心力衰竭患者的预后产生重要影响。尽管心力衰竭的推荐药物干预可能有助于肾功能障碍的发展或使其恶化，但在未选择的社区人群中，这些干预措施与肾功能之间的关系尚未得到充分探讨。方法和目的：我们研究了意大利急性心力衰竭调查中招募的 1008 例患者，以评估肾功能障碍的患病率、预后作用，以及住院期间和 6 个月随访期间肾功能变化与药物干预之间的关系。患者根据肾小球滤过率测定的肾功能程度，使用国家肾脏基金会的标准进行分类。
入院时 59%的患者和出院时 61%的患者被诊断为中重度肾功能障碍。这些患者年龄较大，且糖尿病、贫血、高血压史、心肌梗死和心力衰竭住院史的患病率高于肾功能正常或轻度受损的患者。入院时，前者比后者更频繁地使用利尿剂、血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）治疗。住院期间利尿剂的剂量更高，使用时间更长，而β受体阻滞剂、地高辛、醛固酮拮抗剂、ACEi 和 ARB 在中重度肾功能障碍患者中的使用频率低于无肾功能障碍患者。多变量分析显示，住院期间大剂量利尿剂治疗、无法开始或维持β受体阻滞剂以及出院时未开具 ACEi/ARB，是 6 个月随访时死亡的预测因素（死亡率=14%），独立于肾功能障碍的持续时间、贫血、男性和心力衰竭史。
在急性心力衰竭中，肾功能障碍很常见，并影响预后。在这种情况下，药物干预与肾功能变化和 6 个月死亡率显著相关。
