Pinier Cédric, Gatault Philippe, Fauchier Laurent, Angoulvant Denis, François Maud, Barbet Christelle, Bailly Elodie, Noble Johan, Chevallier Eloi, Rabot Nolwenn, Büchler Matthias, Sautenet Bénédicte, Halimi Jean-Michel
Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France.
EA4245, François-Rabelais University, Tours, France.
Clin Kidney J. 2019 Apr 16;13(1):17-23. doi: 10.1093/ckj/sfz028. eCollection 2020 Feb.
Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus.
We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000-13 period.
The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m. During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06-11.4]; AF: HR 5.42 (3.91-7.52); ACS: HR 8.82 (6.24-12.5); all P < 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01-7.60), P < 0.0001; AF: HR 3.48 (2.30-5.21), P < 0.0001; ACS: HR 2.31 (1.43-3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin-angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD.
Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes.
在糖尿病中，主要心血管事件（MCVE）与肾脏事件之间的关联已得到认可，然而，在2型糖尿病中，心房颤动（AF）、心力衰竭（HF）和急性冠状动脉综合征（ACS）对终末期肾病（ESRD）风险的具体影响尚不明确，而这些疾病在已确定的肾脏危险因素之上。
我们对2000年至2013年期间在肾脏病科连续随访的861例患者进行了一项回顾性研究。
平均年龄为70±10岁，男性占65.1%，估计肾小球滤过率（eGFR）为42.4±21.0 mL/min/1.73m²。在随访期间（中位时间59个月），194例患者发展至终末期肾病。AF、HF或ACS病史与基线eGFR降低的风险增加相关。反过来，基线eGFR降低导致随访期间发生新的MCVE（尤其是HF）的风险更高。最后，所有新的MCVE都是随后急性肾损伤（AKI）的危险因素{HF：风险比[HR]8.99[95%置信区间（CI）7.06-11.4]；AF：HR 5.42（3.91-7.52）；ACS：HR 8.82（6.24-12.5）；所有P<0.0001}和ESRD[HF：HR 5.52（95%CI 4.01-7.60），P<0.0001；AF：HR 3.48（2.30-5.21），P<0.0001；ACS：HR 2.31（1.43-3.73），P=0.0006]。在对ESRD的所有肾脏危险因素（性别、血压、eGFR、蛋白尿、肾素-血管紧张素阻滞剂、视网膜病变和AKI）进行调整后，AF和HF相关的ESRD风险仍然显著，但ACS的关联较弱。重要的是，未发现其他主要事件如中风或感染与ESRD风险之间存在关联。
既往和新发心血管事件（HF和AF多于ACS）对糖尿病患者ESRD的发生发展具有强烈的独立影响超越了已确定的危险因素。
