Department of Nephrology, Keelung Chang Gung Memorial Hospital, Taipei; and College of Medicine, Chang Gung University, Taipei - Taiwan.
J Nephrol. 2010 Mar-Apr;23(2):181-8.
Coronary artery disease (CAD) and chronic kidney disease (CKD) lead to high morbidity and mortality rates. Traditional and nontraditional risk factors, hypertension, fluid overloading and anemia can lead to myocardial ischemia, chamber hypertrophy and dilatation, and low left ventricular ejection fraction (LVEF) in CKD patients. The angiographic feature, ventriculographic LVEF and its relationship to all-cause mortality are unclear in patients with different stages of CKD who are not yet on dialysis.
This retrospective study involved 980 CKD patients with suspected myocardial ischemia who underwent coronary angiography from 1995 to 2004. Demographic, clinical data and ventriculographic LVEF were assessed. Risk estimations for mortality were performed using Cox proportional hazard regression models.
Of the CKD patients, 445 (45.4%) had angiographic CAD. Their hemoglobin, body mass index (BMI) and LVEF values decreased with decrease in eGFR. Using Cox proportional hazard regression analysis, low LVEF was independently associated with CKD after adjustment for age, sex, diabetes, hypertension, BMI, hemoglobin and the presence of CAD. Significant independent prognostic factors for mortality included diabetes (hazard ratio [HR] = 2.946; 95% confidence interval [95% CI], 1.185-7.322), BMI (HR=0.864; 95% CI, 0.757-0.985), hemoglobin (HR=0.742; 95% CI, 0.594-0.928) and LVEF (HR=0.944; 95% CI, 0.918-0.970). Low LVEF was the only independent significant prognostic factor in CKD patients with angiographic CAD (HR=0.957; 95% CI, 0.918-0.996).
LVEF reduction was independently associated with CKD. Low LVEF was an independent predictor of mortality in CKD patients regardless of the presence of angiographic CAD.
冠心病（CAD）和慢性肾脏病（CKD）导致高发病率和死亡率。传统和非传统危险因素，如高血压、液体超负荷和贫血，可导致 CKD 患者发生心肌缺血、心室肥大和扩张以及左心室射血分数（LVEF）降低。在尚未接受透析的不同 CKD 阶段患者中，其血管造影特征、心室造影 LVEF 及其与全因死亡率的关系尚不清楚。
本回顾性研究纳入了 1995 年至 2004 年间接受冠状动脉造影检查的 980 例疑似心肌缺血的 CKD 患者。评估了人口统计学、临床数据和心室造影 LVEF。使用 Cox 比例风险回归模型对死亡率进行风险估计。
在 CKD 患者中，445 例（45.4%）存在血管造影 CAD。随着 eGFR 的降低，其血红蛋白、体重指数（BMI）和 LVEF 值也降低。使用 Cox 比例风险回归分析，在校正年龄、性别、糖尿病、高血压、BMI、血红蛋白和 CAD 存在后，低 LVEF 与 CKD 独立相关。死亡率的显著独立预后因素包括糖尿病（风险比[HR] = 2.946；95%置信区间[95%CI]，1.185-7.322）、BMI（HR=0.864；95%CI，0.757-0.985）、血红蛋白（HR=0.742；95%CI，0.594-0.928）和 LVEF（HR=0.944；95%CI，0.918-0.970）。低 LVEF 是血管造影 CAD 患者 CKD 的唯一独立显著预后因素（HR=0.957；95%CI，0.918-0.996）。
LVEF 降低与 CKD 独立相关。无论是否存在血管造影 CAD，低 LVEF 都是 CKD 患者死亡率的独立预测因素。
