Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital, Letterkenny, Donegal, Ireland.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1982-9. doi: 10.2215/CJN.01130211. Epub 2011 Jul 22.
Congestive heart failure (CHF) is a major risk factor for death in end-stage kidney disease; however, data on prevalence and survival trends are limited. The objective of this study was to determine the prevalence and mortality effect of CHF in successive incident dialysis cohorts.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based cohort of incident US dialysis patients (n = 926,298) from 1995 to 2005. Age- and gender-specific prevalence of CHF was determined by incident year, whereas temporal trends in mortality were compared using multivariable Cox regression.
The prevalence of CHF was significantly higher in women than men and in older than younger patients, but it did not change over time in men (range 28% to 33%) or women (range 33% to 36%). From 1995 to 2005, incident death rates decreased for younger men (≤70 years) and increased for older men (>70 years). For women, the pattern was similar but less impressive. During this period, the adjusted mortality risks (relative risk [RR]) from CHF decreased in men (from RR = 1.06 95% Confidence intervals (CI) 1.02-1.11 in 1995 to 0.91 95% CI 0.87-0.96 in 2005) and women (from RR = 1.06 95% CI 1.01-1.10 in 1995 to 0.90 95% CI 0.85-0.95 in 2005 compared with referent year 2000; RR = 1.00). The reduction in mortality over time was greater for younger than older patients (20% to 30% versus 5% to 10% decrease per decade).
Although CHF remains a common condition at dialysis initiation, mortality risks in US patients have declined from 1995 to 2005.
充血性心力衰竭（CHF）是终末期肾病患者死亡的主要危险因素；然而，关于患病率和生存趋势的数据有限。本研究的目的是确定连续发生的透析队列中 CHF 的患病率和死亡率的影响。
设计、地点、参与者和测量方法：这是一项基于人群的美国透析患者（n=926298）的新发病例队列，研究时间为 1995 年至 2005 年。按发病年份确定 CHF 的年龄和性别特异性患病率，使用多变量 Cox 回归比较死亡率的时间趋势。
女性 CHF 的患病率明显高于男性，老年患者高于年轻患者，但男性（范围 28%至 33%）或女性（范围 33%至 36%）患病率并未随时间变化。从 1995 年到 2005 年，年轻男性（≤70 岁）的新发病死率下降，而老年男性（>70 岁）的新发病死率上升。对于女性，情况类似，但不太明显。在此期间，男性的调整死亡率风险（相对风险[RR]）从 CHF 降低（从 1995 年的 RR=1.06，95%置信区间[CI]1.02-1.11 降至 2005 年的 RR=0.91，95%CI0.87-0.96），女性（从 1995 年的 RR=1.06，95%CI1.01-1.10 降至 2005 年的 RR=0.90，95%CI0.85-0.95，与参考年 2000 年相比；RR=1.00）。与年龄较大的患者相比，年轻患者的死亡率随时间下降幅度更大（每十年下降 20%至 30%，而下降 5%至 10%）。
尽管 CHF 仍是透析开始时的常见病症，但美国患者的死亡率自 1995 年至 2005 年已有所下降。
