Kim Chan Joon, Choi Ik-Jun, Park Hun-Jun, Kim Tae Hoon, Kim Pum-Joon, Chang Kiyuk, Baek Sang Hong, Chung Wook Sung, Seung Ki-Bae
Division of Cardiology, Department of Internal Medicine, Daejon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Inchon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Inchon, Republic of Korea.
Cardiorenal Med. 2016 Aug;6(4):269-78. doi: 10.1159/000443339. Epub 2016 Apr 28.
Dysfunctional interplay between the heart and kidneys may lead to the development of anemia. The aim of this study was to evaluate the impact of cardiorenal anemia syndrome (CRAS) on short- and long-term outcomes among patients hospitalized with heart failure (HF).
We enrolled 303 patients hospitalized with HF. We divided the patients into two groups: a CRAS group (n = 64) and a non-CRAS group (n = 239). We defined CRAS as HF accompanied by (1) an estimated glomerular filtration rate <60 ml/min/1.73 m(2) calculated by the Modification of Diet in Renal Disease at admission and (2) a hemoglobin level <12 g/dl for females and <13 g/dl for males at admission. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction and rehospitalization for HF.
During a median follow-up period of 25.6 months (range 0.1-35.3 months), the patients with CRAS had a significantly increased risk for the primary outcome (27.5 vs. 10.7%, p < 0.001) compared with the patients in the non-CRAS group. Using Cox proportional hazard analyses, the hazard ratio (HR) for the presence of CRAS was found to be 1.874 (95% confidence interval [CI] 1.011-3.475, p = 0.046); HRs were also computed for the presence of diabetes mellitus (HR = 2.241, 95% CI 1.221-4.112, p = 0.009), New York Heart Association class III or IV HF (HR = 2.948, 95% CI 1.206-7.205, p = 0.018) and the use of intravenous loop diuretics (HR = 2.286, 95% CI 0.926-5.641, p = 0.073).
Renal dysfunction and anemia are a fatal combination and are associated with poor prognosis in patients with HF.
心脏与肾脏之间的功能失调相互作用可能导致贫血的发生。本研究的目的是评估心肾贫血综合征（CRAS）对心力衰竭（HF）住院患者短期和长期预后的影响。
我们纳入了303例HF住院患者。我们将患者分为两组：CRAS组（n = 64）和非CRAS组（n = 239）。我们将CRAS定义为HF伴有（1）入院时根据肾脏病饮食改良法计算的估计肾小球滤过率<60 ml/min/1.73 m²，以及（2）入院时女性血红蛋白水平<12 g/dl，男性血红蛋白水平<13 g/dl。主要结局是心脏性死亡、非致命性心肌梗死和因HF再次住院的复合结局。
在中位随访期25.6个月（范围0.1 - 35.3个月）内，与非CRAS组患者相比，CRAS组患者发生主要结局的风险显著增加（27.5%对10.7%，p < 0.001）。使用Cox比例风险分析，发现存在CRAS的风险比（HR）为1.874（95%置信区间[CI]为1.011 - 3.475，p = 0.046）；还计算了糖尿病存在情况的HR（HR = 2.241，95% CI为1.221 - 4.112，p = 0.009）、纽约心脏协会III或IV级HF的HR（HR = 2.948，95% CI为1.206 - 7.205，p = 0.018）以及使用静脉襻利尿剂的HR（HR = 2.286，95% CI为0.926 - 5.641，p = 0.073）。
肾功能不全和贫血是一种致命组合，与HF患者的不良预后相关。
