University of California, San Francisco, General Internal Medicine, San Francisco VA Medical Center, 4150 Clement St., 111A1, San Francisco, CA 94109, USA.
J Card Fail. 2011 Jan;17(1):17-23. doi: 10.1016/j.cardfail.2010.08.009.
Epidemiological studies typically diagnose heart failure (HF) at the time of hospitalization, and have not evaluated the prevalence of HF symptoms in CKD patients without a prior HF diagnosis.
We modified the Kansas City Cardiomyopathy Questionnaire (KCCQ) to detect and quantify symptoms characteristic of HF (dyspnea, edema, and fatigue) among 2883 chronic kidney disease (CKD) patients without diagnosed heart failure in the Chronic Renal Insufficiency Cohort (CRIC). The KCCQ is a 23-item instrument that quantifies the impact of dyspnea, fatigue, and edema on physical, social, and emotional functions (scored 0 to 100). The median KCCQ score was 92, and 25% had KCCQ scores <75. Compared with cystatin C‑based estimated glomerular filtration rate >50 mL·min·1.73 m(2) (reference), estimated glomerular filtration rate 40 to 50, 30 to 40, and <30 were independently associated with lower KCCQ scores (<75); adjusted odds ratios and (95% CI): 1.38 (1.06-1.78), 1.39 (1.09-1.82), and 2.15 (1.54-3.00), respectively. Lower hemoglobin (Hb) levels also had independent associations with KCCQ <75: Hb >14 g/dL (reference), Hb 13 to 14 g/dL (1.03; 0.76-1.40), Hb 12 to 13 g/dL (1.41; 1.04-1.91), Hb 11 to 12 g/dL (1.56; 1.12-2.16); and Hb <1 g/dL (1.65; 1.15-2.37).
CKD patients without diagnosed HF have a substantial burden of symptoms characteristic of HF, particularly among those with lower estimated glomerular filtration rate and hemoglobin levels.
流行病学研究通常在住院时诊断心力衰竭(HF),并未评估先前未诊断 HF 的 CKD 患者的 HF 症状的患病率。
我们修改了堪萨斯城心肌病问卷(KCCQ),以检测和量化 2883 例慢性肾脏病(CKD)患者中无诊断心力衰竭的慢性肾功能不全队列(CRIC)中 HF 特征性症状(呼吸困难,水肿和疲劳)。KCCQ 是一种 23 项工具,可量化呼吸困难,疲劳和水肿对身体,社会和情感功能的影响(评分 0 至 100)。KCCQ 的中位数评分为 92,25%的 KCCQ 评分<75。与胱抑素 C 估计肾小球滤过率>50 mL·min·1.73 m2(参考)相比,估计肾小球滤过率为 40 至 50、30 至 40 和<30 与较低的 KCCQ 评分(<75)独立相关;调整后的优势比和(95%CI):1.38(1.06-1.78),1.39(1.09-1.82)和 2.15(1.54-3.00)。较低的血红蛋白(Hb)水平也与 KCCQ<75 独立相关:Hb>14 g/dL(参考),Hb 13 至 14 g/dL(1.03;0.76-1.40),Hb 12 至 13 g/dL(1.41;1.04-1.91),Hb 11 至 12 g/dL(1.56;1.12-2.16);和 Hb<1 g/dL(1.65;1.15-2.37)。
先前未诊断 HF 的 CKD 患者 HF 特征性症状负担很大,尤其是在估计肾小球滤过率和血红蛋白水平较低的患者中。