Casado J, Montero M, Formiga F, Camafort M, Sánchez C, Muela A, Díez J, Pérez J I
Servicio de Medicina Interna, Hospital del Henares, Coslada, Madrid, España.
Rev Clin Esp. 2012 Mar;212(3):119-26. doi: 10.1016/j.rce.2011.12.005. Epub 2012 Feb 2.
Impaired renal function can lead to a poor prognosis in patients with heart failure (HF). This study analyses the prevalence and prognostic value of impaired renal function in a cohort of patients with HF.
We analysed patients who were included in the RICA study (multicentre, prospective cohort study) who were admitted for decompensated HF in 52 Spanish Internal Medicine Departments between March 2008 and September 2009. The patients were grouped according to their renal function, evaluated by eGF, using the MDRD formula.
A total of 714 patients (54% women) with a mean age of 77.3+8.7 years were included. Of these, 84% had hypertension, and hypertensive heart disease was the most common aetiology of HF (39.2%). Ejection fraction was normal in 64.7% of patients, and 59.5% had an eGF less than 60 mL/min per 1.73 m(2), and 11.2% with an eGF less than 30 mL/min per 1.73 m(2). Less spironolactone was prescribed in patients with advanced stages of renal dysfunction (24%), compared with patients with an eGF>60 mL/min/1.73 m(2) (35%; P=.025). Worsening renal function was independently associated with an increased mortality risk (RR: 2.05; 95% CI: 1.13-3.71; P=.018).
About 60% of patients admitted to Internal Medicine with HF have impaired renal function. This comorbidity is associated with a two-fold increase in all-cause mortality.
肾功能受损会导致心力衰竭（HF）患者预后不良。本研究分析了一组HF患者中肾功能受损的患病率及其预后价值。
我们分析了纳入RICA研究（多中心前瞻性队列研究）的患者，这些患者于2008年3月至2009年9月期间在西班牙52个内科科室因失代偿性HF入院。根据使用MDRD公式通过估算肾小球滤过率（eGF）评估的肾功能对患者进行分组。
共纳入714例患者（54%为女性），平均年龄77.3±8.7岁。其中，84%患有高血压，高血压性心脏病是HF最常见的病因（39.2%）。64.7%的患者射血分数正常，59.5%的患者eGF低于60 mL/（min·1.73 m²），11.2%的患者eGF低于30 mL/（min·1.73 m²）。与eGF>60 mL/（min·1.73 m²）的患者相比，肾功能不全晚期患者使用螺内酯的比例较低（24%）（35%；P = 0.025）。肾功能恶化与死亡风险增加独立相关（RR：2.05；95%CI：1.13 - 3.71；P = 0.018）。
约60%因HF入住内科的患者存在肾功能受损。这种合并症与全因死亡率增加两倍相关。
