Department of Cardiology, Karolinska University Hospital, Huddinge, Institution of Medicine (H7), Huddinge; Karolinska Institutet, 141 86, Stockholm, Sweden.
Department of Cardiology and Department of Medical and Health Sciences, Linköping University Hospital, Linköping, Sweden.
Eur J Heart Fail. 2017 Dec;19(12):1606-1614. doi: 10.1002/ejhf.821. Epub 2017 Mar 29.
AIMS: As the role of chronic kidney disease (CKD) in different types of heart failure (HF) is poorly understood, our aim was to compare CKD in HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) with regard to prevalence, associations and prognostic role. METHODS AND RESULTS: Patients in the Swedish Heart Failure Registry were divided into three groups based on EF (≥50%, 40-49% and <40%). CKD was defined as an estimated glomerular filtration rate ≤60 mL/min.1.73 m . Associations between covariates and CKD and between CKD and mortality were assessed with multivariable regressions. Of 40 230 patients, 8875 (22%) had HFpEF, 8374 (21%) had HFmrEF, and 22 981 (57%) had HFrEF, with a CKD prevalence of 56%, 48%, and 45%, respectively. Associations between covariates and CKD were similar in all EF groups. One-year mortality with vs. without CKD was 23% vs. 13% in HFpEF, 22% vs. 8% in HFmrEF, and 23% vs. 8% in HFrEF (P < 0.001 for all). After adjustment, CKD was more strongly associated with death in HFrEF and HFmrEF than in HFpEF [hazard ratio (HR) and 95% confidence interval (CI); 1.49 (1.42-1.56) and 1.51 (1.40-1.63) vs. 1.32 (1.24-1.42); P for interaction <0.001]. In receiver operating characteristic (ROC) analyses, CKD was also a stronger predictor of death in HFrEF and HFmrEF than in HFpEF [area under the curve (AUC) 0.699 (0.689-0.709) and 0.700 (0.683-0.716) vs. 0.629 (0.613-0.645)]. CONCLUSION: CKD was associated with similar covariates regardless of EF. Although CKD was more common in HFpEF than in HFmrEF and HFrEF, it may have more of a 'bystander' role in HFpEF, being less associated with mortality and with lower prognostic discrimination.
目的：由于慢性肾脏病（CKD）在不同类型心力衰竭（HF）中的作用尚不清楚，我们旨在比较射血分数保留型心力衰竭（HFpEF）、射血分数中间值型心力衰竭（HFmrEF）和射血分数降低型心力衰竭（HFrEF）中 CKD 的患病率、相关性和预后作用。
方法和结果：根据 EF（≥50%、40-49%和<40%），将瑞典心力衰竭注册中心的患者分为三组。CKD 定义为估算肾小球滤过率≤60mL/min.1.73m。使用多变量回归评估协变量与 CKD 之间以及 CKD 与死亡率之间的相关性。在 40230 名患者中，8875 名（22%）患有 HFpEF，8374 名（21%）患有 HFmrEF，22981 名（57%）患有 HFrEF，CKD 的患病率分别为 56%、48%和 45%。EF 各组之间协变量与 CKD 的相关性相似。与无 CKD 相比，HFpEF 中有 CKD 的患者 1 年死亡率为 23%比 13%，HFmrEF 中有 CKD 的患者 1 年死亡率为 22%比 8%，HFrEF 中有 CKD 的患者 1 年死亡率为 23%比 8%（所有 P<0.001）。调整后，与 HFpEF 相比，CKD 与 HFrEF 和 HFmrEF 死亡的相关性更强[危险比（HR）和 95%置信区间（CI）；1.49（1.42-1.56）和 1.51（1.40-1.63）比 1.32（1.24-1.42）；P 交互<0.001]。在接受者操作特征（ROC）分析中，与 HFpEF 相比，CKD 也是 HFrEF 和 HFmrEF 死亡的更强预测因子[曲线下面积（AUC）0.699（0.689-0.709）和 0.700（0.683-0.716）比 0.629（0.613-0.645）]。
结论：无论 EF 如何，CKD 与相似的协变量相关。尽管 CKD 在 HFpEF 中比在 HFmrEF 和 HFrEF 中更为常见，但它在 HFpEF 中可能具有更多的“旁观者”作用，与死亡率的相关性较低，预后预测能力较低。
Eur J Heart Fail. 2017-9-25
JACC Heart Fail. 2017-7-12
JACC Heart Fail. 2019-3-6
Int J Cardiol Cardiovasc Risk Prev. 2025-3-6
Rev Cardiovasc Med. 2025-3-5
Zotero 插件