Department of Nephrology, Ullevål University Hospital, Oslo, Norway.
J Card Fail. 2010 May;16(5):374-80. doi: 10.1016/j.cardfail.2010.01.001. Epub 2010 Mar 3.
Impaired renal function confers an adverse prognosis in patients with heart failure (HF). The aims of the present study were to identify factors associated with and predictive of impaired renal function and to assess the relationship between estimated glomerular filtration rate (eGFR) and all-cause mortality in outpatients with HF.
Baseline data on 3605 patients (median age 73 years, 70.1% men) from 24 outpatient HF clinics in Norway were analyzed. Median follow-up time was 9 months. Renal dysfunction (eGFR < 60 mL/min) was present in 44.9%. The population was randomized into equal-sized model-building and validation samples to enhance model stability. eGFR was an independent predictor of all-cause mortality (HR 0.94 per 5 mL/min increase, P = .001). Use of spironolactone (P = .002), higher blood pressure (P < .001), and lower hemoglobin levels (P = .002) were predictors of impaired renal function. Increasing doses of loop diuretics were strongly associated with eGFR at baseline (P < .001), but only tended to predict worsening renal function during follow-up (P = .08).
Clinically significant reduction in renal function was prevalent in outpatients with HF, and was a strong predictor of all-cause mortality. Use of loop diuretics and spironolactone should be carefully evaluated as these agents may adversely affect renal function.
肾功能受损会使心力衰竭（HF）患者的预后恶化。本研究的目的是确定与肾功能受损相关的因素和预测因素，并评估估算肾小球滤过率（eGFR）与门诊 HF 患者全因死亡率之间的关系。
对来自挪威 24 个门诊 HF 诊所的 3605 名患者（中位年龄 73 岁，70.1%为男性）的基线数据进行了分析。中位随访时间为 9 个月。肾功能障碍（eGFR < 60 mL/min）存在于 44.9%的患者中。人群被随机分为等大小的模型构建和验证样本，以增强模型稳定性。eGFR 是全因死亡率的独立预测因素（每增加 5 mL/min，HR 为 0.94，P =.001）。螺内酯的使用（P =.002）、较高的血压（P <.001）和较低的血红蛋白水平（P =.002）是肾功能受损的预测因素。在基线时，环利尿剂的剂量增加与 eGFR 强烈相关（P <.001），但仅在随访期间有趋势表明会恶化肾功能（P =.08）。
门诊 HF 患者中普遍存在明显的肾功能下降，是全因死亡率的强预测因素。应仔细评估环利尿剂和螺内酯的使用，因为这些药物可能会对肾功能产生不利影响。
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