Department of Medicine, University of Washington, Seattle, Washington.
Department of Medicine, University of Washington, Seattle, Washington.
J Am Coll Cardiol. 2019 Jun 4;73(21):2691-2700. doi: 10.1016/j.jacc.2019.02.071.
Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited.
This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death.
The prospective CRIC (Chronic Renal Insufficiency Cohort) study measured the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) at baseline. The crude rates and rate ratios of HF hospitalizations and 30-day HF re-hospitalizations were calculated using Poisson regression models. Cox regression was used to assess the association of the frequency of HF hospitalizations within the first 2 years of follow-up with risk of subsequent CKD progression and death.
Among 3,791 participants, the crude rate of HF admissions was 5.8 per 100 person-years (with higher rates of HF with preserved ejection fraction vs. HF with reduced ejection fraction). The adjusted rate of HF was higher with a lower eGFR (vs. eGFR >45 ml/min/1.73 m); the rate ratios were 1.7 and 2.2 for eGFR 30 to 44 and <30 ml/min/1.73 m (vs. >45 ml/min/1.73 m), respectively. Similarly, the adjusted rates of HF hospitalization were significantly higher in those with higher urine ACR (vs. urine ACR <30 mg/g); the rate ratios were 1.9 and 2.6 for urine ACR 30 to 299 and ≥300 mg/g, respectively. Overall, 20.6% of participants had a subsequent HF re-admission within 30 days. HF hospitalization within 2 years of study entry was associated with greater adjusted risks for CKD progression (1 hospitalization: hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.40 to 2.67; 2+ hospitalizations: HR: 2.14; 95% CI: 1.30 to 3.54) and all-cause death (1 hospitalization: HR: 2.20; 95% CI: 1.71 to 2.84; 2+ hospitalizations: HR: 3.06; 95% CI: 2.23 to 4.18).
Within a large U.S. CKD population, the rates of HF hospitalizations and re-hospitalization were high, with even higher rates across categories of lower eGFR and higher urine ACR. Patients with CKD hospitalized with HF had greater risks of CKD progression and death. HF prevention and treatment should be a public health priority to improve CKD outcomes.
有关慢性肾脏病（CKD）患者心力衰竭（HF）住院率、再住院率以及与 HF 住院相关结局的数据有限。
本研究旨在调查大量 CKD 人群中的 HF 住院率和再住院率，并评估 HF 住院的负担与随后 CKD 进展和死亡的风险。
前瞻性 CRIC（慢性肾功能不全队列）研究在基线时测量了估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）。使用泊松回归模型计算 HF 住院和 30 天 HF 再住院的粗率和率比。使用 Cox 回归评估随访前 2 年内 HF 住院频率与随后 CKD 进展和死亡风险的相关性。
在 3791 名参与者中，HF 入院的粗率为 5.8/100 人年（射血分数保留性心力衰竭的 HF 入院率高于射血分数降低性心力衰竭）。eGFR 较低时，HF 的调整后发生率较高（与 eGFR>45 ml/min/1.73 m 相比）；eGFR 为 30 至 44 和<30 ml/min/1.73 m 时的率比分别为 1.7 和 2.2（与 eGFR>45 ml/min/1.73 m 相比）。同样，尿液 ACR 较高时，HF 住院的调整后发生率显著升高（尿液 ACR<30 mg/g 时）；尿液 ACR 为 30 至 299 和≥300 mg/g 时的率比分别为 1.9 和 2.6。总体而言，20.6%的参与者在 30 天内再次因 HF 住院。研究入组后 2 年内的 HF 住院与 CKD 进展的调整后风险增加相关（1 次住院：风险比[HR]：1.93；95%置信区间[CI]：1.40 至 2.67；2 次或以上住院：HR：2.14；95%CI：1.30 至 3.54）和全因死亡（1 次住院：HR：2.20；95%CI：1.71 至 2.84；2 次或以上住院：HR：3.06；95%CI：2.23 至 4.18）。
在美国大型 CKD 人群中，HF 住院和再住院的发生率很高，在 eGFR 较低和尿液 ACR 较高的类别中，HF 住院的发生率更高。HF 住院的 CKD 患者的 CKD 进展和死亡风险更高。HF 的预防和治疗应成为改善 CKD 结局的公共卫生重点。
