Parfrey P S, Griffiths S M, Harnett J D, Taylor R, King A, Hand J, Barre P E
Division of Nephrology, Memorial University of Newfoundland, St. John's, Canada.
Am J Nephrol. 1990;10(3):213-21. doi: 10.1159/000168084.
Congestive heart failure in dialysis patients is associated with dilated cardiomyopathy, hypertrophic hyperkinetic disease and ischemic heart disease. To determine the natural history of these four diseases, 150 dialysis patients were prospectively followed for 3-5 years. The 2-year cumulative survival rate was 33% in those with recurrent or persistent congestive heart failure vs. 80% in dialysis patients without. Survival was significantly worse in patients with an echocardiographic diagnosis of dilated cardiomyopathy compared to patients with normal echo-cardiogram (2-year survival rate 67 vs. 90%). In hypertrophic hyperkinetic disease the 2-year survival rate was 30% after entry into the study, and 43% after first admission with congestive heart failure. Symptomatic ischemic heart disease did not have an adverse impact on mortality when compared to those without ischemic heart disease. We conclude that congestive heart failure in dialysis patients has a bad prognosis. Its associated disorders include dilated cardiomyopathy and hypertrophic hyperkinetic disease, the latter being associated with a high mortality. As the prognosis for patients with overt ischemic heart disease was not different from patients without, it is likely that the underlying cardiomyopathy directly influenced survival.
透析患者的充血性心力衰竭与扩张型心肌病、肥厚性高动力性疾病和缺血性心脏病有关。为了确定这四种疾病的自然病程，对150例透析患者进行了为期3至5年的前瞻性随访。复发性或持续性充血性心力衰竭患者的2年累积生存率为33%，而无充血性心力衰竭的透析患者为80%。与超声心动图正常的患者相比，超声心动图诊断为扩张型心肌病的患者生存率明显更差（2年生存率分别为67%和90%）。在肥厚性高动力性疾病中，进入研究后的2年生存率为30%，首次因充血性心力衰竭入院后的生存率为43%。与无缺血性心脏病的患者相比，有症状的缺血性心脏病对死亡率没有不利影响。我们得出结论，透析患者的充血性心力衰竭预后不良。其相关疾病包括扩张型心肌病和肥厚性高动力性疾病，后者与高死亡率相关。由于明显缺血性心脏病患者的预后与无缺血性心脏病的患者无异，因此很可能潜在的心肌病直接影响了生存率。
