Oh Jaewon, Kang Seok-Min, Song Mi Kyung, Hong Namki, Youn Jong-Chan, Han Seongwoo, Jeon Eun-Seok, Cho Myeong-Chan, Kim Jae-Joong, Yoo Byung-Su, Chae Shung Chull, Oh Byung-Hee, Choi Dong-Ju, Lee Myung-Mook, Ryu Kyu-Hyung
Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Am Heart J. 2015 May;169(5):713-720.e3. doi: 10.1016/j.ahj.2015.01.014. Epub 2015 Feb 21.
We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHF patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1.73 m(2)).
We retrospectively analyzed data from the Korean Heart Failure Registry. We included 1,035 ADHF patients with severe renal dysfunction. In Kaplan-Meier survival analysis, all-cause mortality in the spironolactone-treated group was significantly lower than that in the nonspironolactone group (18.1% vs 24.9%, respectively, log rank P = .028). However, spironolactone use was not an independent predictor after adjusting other HF risk factors (hazard ratio 0.974, 95% CI 0.681-1.392, P = .884) and after propensity score matching (P = .115). In subgroup analysis, the clinical benefit of spironolactone use was preserved in women, prehospital spironolactone use, the chronic kidney disease stage 3b (eGFR 30-44 mL/min per 1.73 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L).
The spironolactone therapy was not beneficial in ADHF patients with severe renal dysfunction after multivariable adjusting and propensity score matching. However, we reassured the current HF guidelines for spironolactone use and the clinical benefit in chronic kidney disease stage 3b should be assessed in future clinical trial.
我们研究了螺内酯的使用与严重肾功能不全的急性失代偿性心力衰竭（ADHF）患者全因死亡率之间的关系。螺内酯在治疗心力衰竭（HF）方面的临床益处已在多项大型随机临床试验中得到描述。然而，其在住院的严重肾功能不全（估计肾小球滤过率[eGFR]<45 mL/min/1.73 m²）的ADHF患者中的临床益处尚未得到研究。
我们回顾性分析了韩国心力衰竭登记处的数据。我们纳入了1035例严重肾功能不全的ADHF患者。在Kaplan-Meier生存分析中，螺内酯治疗组的全因死亡率显著低于非螺内酯组（分别为18.1%和24.9%，对数秩检验P = 0.028）。然而，在调整其他HF危险因素后（风险比0.974，95%置信区间0.681-1.392，P = 0.884）以及倾向评分匹配后（P = 0.115），使用螺内酯并非独立预测因素。在亚组分析中，使用螺内酯的临床益处在女性、院前使用螺内酯、慢性肾脏病3b期（eGFR 30-44 mL/min/1.73 m²）以及适当使用螺内酯（eGFR≥30 mL/min/1.73 m²且血钾≤5.0 mmol/L）的患者中得以保留。
在多变量调整和倾向评分匹配后，螺内酯治疗对严重肾功能不全的ADHF患者并无益处。然而，我们重申了当前关于螺内酯使用的HF指南，并且其在慢性肾脏病3b期的临床益处应在未来临床试验中进行评估。
