Stubnova Viera, Os Ingrid, Grundtvig Morten, Atar Dan, Waldum-Grevbo Bård
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Medicine, Finnmark Hospital Trust, Kirkenes, Norway.
Cardiorenal Med. 2017 Feb;7(2):128-136. doi: 10.1159/000454933. Epub 2017 Jan 20.
BACKGROUND/AIMS: Spironolactone may be hazardous in heart failure (HF) patients with renal dysfunction due to risk of hyperkalemia and worsened renal function. We aimed to evaluate the effect of spironolactone on all-cause mortality in HF outpatients with renal dysfunction in a propensity-score-matched study.
A total of 2,077 patients from the Norwegian Heart Failure Registry with renal dysfunction (eGFR <60 mL/min/1.73 m) not treated with spironolactone at the first visit at the HF clinic were eligible for the study. Patients started on spironolactone at the outpatient HF clinics ( = 206) were propensity-score-matched 1:1 with patients not started on spironolactone, based on 16 measured baseline characteristics. Kaplan-Meier and Cox regression analyses were used to investigate the independent effect of spironolactone on 2-year all-cause mortality.
Propensity score matching identified 170 pairs of patients, one group receiving spironolactone and the other not. The two groups were well matched (mean age 76.7 ± 8.1 years, 66.4% males, and eGFR 46.2 ± 10.2 mL/min/1.73 m). Treatment with spironolactone was associated with increased potassium (delta potassium 0.31 ± 0.55 vs. 0.05 ± 0.41 mmol/L, < 0.001) and decreased eGFR (delta eGFR -4.12 ± 12.2 vs. -0.98 ± 7.88 mL/min/1.73 m, = 0.006) compared to the non-spironolactone group. After 2 years, 84% of patients were alive in the spironolactone group and 73% of patients in the non-spironolactone group (HR 0.59, 95% CI 0.37-0.92, = 0.020).
In HF outpatients with renal dysfunction, treatment with spironolactone was associated with improved 2-year survival compared to well-matched patients not treated with spironolactone. Favorable survival was observed despite worsened renal function and increased potassium in the spironolactone group.
背景/目的：由于存在高钾血症风险和肾功能恶化，螺内酯可能对肾功能不全的心力衰竭（HF）患者有害。我们旨在通过一项倾向评分匹配研究，评估螺内酯对肾功能不全的HF门诊患者全因死亡率的影响。
共有2077例来自挪威心力衰竭登记处的患者符合研究条件，这些患者在HF门诊首次就诊时存在肾功能不全（估算肾小球滤过率[eGFR]<60 mL/min/1.73 m²）且未接受螺内酯治疗。在门诊HF诊所开始使用螺内酯治疗的患者（n = 206），根据16项测量的基线特征，与未开始使用螺内酯的患者进行1:1倾向评分匹配。采用Kaplan-Meier和Cox回归分析来研究螺内酯对2年全因死亡率的独立影响。
倾向评分匹配确定了170对患者，一组接受螺内酯治疗，另一组未接受。两组匹配良好（平均年龄76.7±8.1岁，男性占66.4%，eGFR为46.2±10.2 mL/min/1.73 m²）。与未使用螺内酯组相比，使用螺内酯治疗与血钾升高（血钾差值0.31±0.55 vs. 0.05±0.41 mmol/L，P<0.001）和eGFR降低（eGFR差值-4.12±12.2 vs. -0.98±7.88 mL/min/1.73 m²，P = 0.006）相关。2年后，螺内酯组84%的患者存活，未使用螺内酯组73%的患者存活（风险比[HR]0.59，95%置信区间[CI]0.37 - 0.92，P = 0.020）。
在肾功能不全的HF门诊患者中，与匹配良好的未使用螺内酯治疗的患者相比，使用螺内酯治疗与2年生存率提高相关。尽管螺内酯组肾功能恶化且血钾升高，但仍观察到了良好的生存率。
