VA Medical Center, Birmingham, Ala., USA.
Am J Nephrol. 2011;34(2):135-41. doi: 10.1159/000328905. Epub 2011 Jul 4.
The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear.
Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m(2)) data. Of these, 898 (16%) had CKD 3A (eGFR 45-59 ml/min/1.73 m(2)) and 242 (4%) had CKD stage ≥3B (eGFR <45 ml/min/1.73 m(2)). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≥60 ml/min/1.73 m(2) were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics.
During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20-1.63; p < 0.001] and with CKD ≥3B (HR 3.37; 95% CI 2.71-4.18; p < 0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85-1.26; p = 0.746), and 36 and 28% of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95% CI 1.04-2.00; p = 0.027).
Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.
慢性肾脏病（CKD）分期与心力衰竭（HF）事件之间的关系尚不清楚。
在心血管健康研究的 5795 名≥65 岁的社区居住成年人中，5450 名无HF 且基线估算肾小球滤过率（eGFR：ml/min/1.73 m2）数据。其中，898 人（16%）患有 CKD 3A（eGFR 45-59 ml/min/1.73 m2），242 人（4%）患有 CKD 阶段≥3B（eGFR <45 ml/min/1.73 m2）。没有基线蛋白尿数据，4310 名（79%）eGFR≥60 ml/min/1.73 m2 的人被认为没有 CKD。分别为 CKD 3A 和≥3B 估计的倾向评分用于组装两个队列，每个队列有 1714 名参与者（857 对 CKD 3A 和无 CKD）和 557 名参与者（148 名 CKD≥3B 和 409 名无 CKD），分别在 50 个基线特征上平衡。
在 13 年的随访期间，经中心裁定的新发生 HF 在未匹配的参与者中分别为 19%、24%和 38%（无 CKD 作为参考）、CKD 3A [未调整的危险比（HR）1.40；95%置信区间（CI）1.20-1.63；p<0.001]和 CKD≥3B（HR 3.37；95%CI 2.71-4.18；p<0.001）。相比之下，在匹配的参与者中，CKD 3A 和无 CKD 组的新发生 HF 发生率分别为 23%和 23%（HR 1.03；95%CI 0.85-1.26；p=0.746），CKD≥3B 和无 CKD 组的新发生 HF 发生率分别为 36%和 28%（HR 1.44；95%CI 1.04-2.00；p=0.027）。
在社区居住的老年人中，CKD 是 HF 事件的标志物，无论分期如何；然而，CKD≥3B，而不是 CKD 3A，与 HF 事件有适度的独立关联。
