Internal Medicine Service, Hospital Universitario del Henares, Madrid, Spain.
Eur J Intern Med. 2013 Oct;24(7):677-83. doi: 10.1016/j.ejim.2013.06.003. Epub 2013 Jul 3.
Renal dysfunction is common in patients with heart failure (HF) and is associated with high mortality. This relationship is well established in HF and reduced ejection fraction (HFREF), however, it is not fully understood in HF and preserved ejection fraction (HFPEF). The aim of this study was to determine the impact of renal dysfunction on all-cause mortality in HFPEF patients and to evaluate the clinical characteristics of patients that deteriorate renal function in the first year of follow-up.
We evaluated the patients with HFPEF included in the RICA registry. This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF. Estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and plasma creatinine concentrations were used for renal function assessment at admission and after one year of follow up.
A total of 455 patients (mean age 78±8.1years; 62% women) were included, of whom 265 (58.2%) had eGFR<60mL/min/1.73m(2). After adjustment for covariates, only lower admission eGFR remained significantly predictive of all-cause mortality (HR 2.97; 95% CI 1.59-5.53). After one year of follow-up 16.6% of patients deteriorated at least 25% of eGFR. These patients were more likely to be diabetic (54.5% vs 42.6%; p=0.039) and had a higher rate of prescription of mineralcorticoid receptor antagonist (MRA) agents (47% vs 23.3%; p<0.001).
Renal dysfunction is frequently associated with HFPEF. eGFR below normal is strongly associated with mortality. Further decline of renal function is frequent especially among diabetic and patients treated with MRA agents.
肾功能障碍在心力衰竭（HF）患者中很常见，与高死亡率相关。这种关系在射血分数降低的心力衰竭（HFREF）中已经得到很好的证实，但在射血分数保留的心力衰竭（HFPEF）中尚未完全了解。本研究旨在确定肾功能障碍对 HFPEF 患者全因死亡率的影响，并评估在随访的第一年肾功能恶化的患者的临床特征。
我们评估了 RICA 登记处纳入的 HFPEF 患者。这是一项多中心前瞻性队列研究，包括因失代偿性 HF 入院的患者。在入院时和随访一年后，使用估算肾小球滤过率（eGFR）、血尿素氮（BUN）和血浆肌酐浓度评估肾功能。
共纳入 455 例患者（平均年龄 78±8.1 岁；62%为女性），其中 265 例（58.2%）eGFR<60mL/min/1.73m(2)。在校正了混杂因素后，只有较低的入院 eGFR 仍然与全因死亡率显著相关（HR 2.97；95%CI 1.59-5.53）。在随访一年后，16.6%的患者 eGFR 至少下降了 25%。这些患者更有可能患有糖尿病（54.5%比 42.6%；p=0.039），并且更有可能开处方使用盐皮质激素受体拮抗剂（MRA）药物（47%比 23.3%；p<0.001）。
肾功能障碍在 HFPEF 中很常见。正常以下的 eGFR 与死亡率密切相关。肾功能进一步下降很常见，尤其是在糖尿病和接受 MRA 药物治疗的患者中。
