George Lekha K, Koshy Santhosh K G, Molnar Miklos Z, Thomas Fridtjof, Lu Jun L, Kalantar-Zadeh Kamyar, Kovesdy Csaba P
From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.).
Circ Heart Fail. 2017 Aug;10(8). doi: 10.1161/CIRCHEARTFAILURE.116.003825.
Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes.
Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) ≥60 mL min 1.73 m during October 1, 2004 to September 30, 2006, we identified 156 743 with an , , diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min 1.73 m y) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean±standard deviation baseline age and eGFR of HF patients were 68±11 years and 78±14 mL min 1.73 m and in patients without HF were 59±14 years and 84±16 mL min 1.73 m, respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively.
HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications.
心力衰竭（HF）与不良心脏结局及死亡率相关。目前尚不清楚在肾功能正常的患者中，HF是否会导致不良肾脏结局。我们推测HF与更差的长期肾脏结局相关。
在2004年10月1日至2006年9月30日期间，对3570865名估算肾小球滤过率（eGFR）≥60 mL·min⁻¹·1.73 m²的美国退伍军人进行研究，我们识别出156743名诊断为HF的患者。我们使用Cox比例风险分析和逻辑回归，研究HF与新发慢性肾脏病（CKD）、新发CKD或死亡率的复合结局以及eGFR快速下降（斜率陡于-5 mL·min⁻¹·1.73 m²·年）之间的关联。对各种混杂因素进行了校正。HF患者的平均±标准差基线年龄和eGFR分别为68±11岁和78±14 mL·min⁻¹·1.73 m²，无HF患者分别为59±14岁和84±16 mL·min⁻¹·1.73 m²。HF患者高血压、糖尿病、心脏、外周血管和慢性肺部疾病、中风及痴呆的患病率更高。HF患者的CKD发病率为69.0/1000患者年，无HF患者为14.5/1000患者年，22%的HF患者eGFR快速下降，而无HF患者为8.5%。HF患者发生新发CKD、CKD或死亡率的复合结局以及eGFR快速下降的多变量校正风险分别高出2.12倍、2.06倍和2.13倍。
HF与新发CKD、新发CKD或死亡率的复合结局以及eGFR快速下降的风险显著升高相关。HF的早期诊断和管理有助于降低长期肾脏并发症的风险。
