Otaki Yoichiro, Watanabe Tetsu, Konta Tsuneo, Tamura Harutoshi, Kato Shigehiko, Nishiyama Satoshi, Takahashi Hiroki, Arimoto Takanori, Shishido Tetsuro, Watanabe Masafumi
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan.
Heart Vessels. 2020 Feb;35(2):187-196. doi: 10.1007/s00380-019-01472-4. Epub 2019 Jul 22.
Kidney dysfunction (KD) is closely associated with poor clinical outcome in patients with heart failure (HF). KD is classified as intrinsic and pre-renal KD. However, the impact of each KD on the clinical outcome in patients with HF has not yet been fully elucidated. We measured the urinary to serum creatinine (UC/SC) ratio, a marker for intrinsic and pre-renal KD, in 1009 consecutive patients with HF at admission. There were 314 cardio-renal events including HF and advanced end-stage renal dysfunction during the median follow-up period of 1154 days. There were 63 (6%) patients with intrinsic KD (UC/SC ratio < 20), 118 (12%) patients with intermediate KD (UC/SC ratio 20-40), 607 (60%) patients with pre-renal KD (UC/SC ratio > 40), and 221 (22%) patients with no KD. Multivariate Cox's proportional hazard regression analysis demonstrated that intrinsic and intermediate KDs were significantly associated with poor clinical outcome. The prediction model for cardio-renal events was significantly improved by the addition of UC/SC ratio to the confounding risk factors. Subgroup analysis in patients with HF with severely reduced glomerular filtration rates showed that the prevalence rates of intrinsic, intermediate, and pre-renal KDs were 23%, 30%, and 47%, respectively. The cardio-renal event rate was the highest in the intrinsic KD group compared with that in the other groups. Intrinsic KD was closely associated with extremely poor clinical outcome in patients with HF. The UC/SC ratio could provide important clinical information for the treatment and management of KD in patients with HF.
肾功能不全（KD）与心力衰竭（HF）患者不良临床结局密切相关。KD分为内在性和肾前性KD。然而，每种KD对HF患者临床结局的影响尚未完全阐明。我们在1009例连续入院的HF患者中测量了尿肌酐与血清肌酐（UC/SC）比值，这是内在性和肾前性KD的一个标志物。在1154天的中位随访期内，发生了314例心肾事件，包括HF和晚期终末期肾功能不全。有63例（6%）内在性KD患者（UC/SC比值<20），118例（12%）中度KD患者（UC/SC比值20 - 40），607例（60%）肾前性KD患者（UC/SC比值>40），以及221例（22%）无KD患者。多变量Cox比例风险回归分析表明，内在性和中度KD与不良临床结局显著相关。将UC/SC比值添加到混杂风险因素中，心肾事件预测模型有显著改善。在肾小球滤过率严重降低的HF患者亚组分析中，内在性、中度和肾前性KD的患病率分别为23%、30%和47%。与其他组相比，内在性KD组的心肾事件发生率最高。内在性KD与HF患者极差的临床结局密切相关。UC/SC比值可为HF患者KD的治疗和管理提供重要临床信息。
