肾功能不全和心力衰竭老年患者的β受体阻滞剂治疗
Beta-blocker therapy in elderly patients with renal dysfunction and heart failure.
作者信息
Martínez-Milla Juan, García Marcelino Cortés, Palfy Julia Anna, Urquía Mikel Taibo, Castillo Marta López, Arbiol Ana Devesa, Monteagudo Ana Lucía Rivero, Mariscal María Luisa Martín, Jiménez-Varas Inés, Figuero Sem Briongos, Franco-Pelaéz Juan Antonio, Tuñón José
机构信息
Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz-Quirónsalud.
Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
出版信息
J Geriatr Cardiol. 2021 Jan 28;18(1):20-29. doi: 10.11909/j.issn.1671-5411.2021.01.005.
OBJECTIVE
To assess the role of beta-blockers (BB) in patients with chronic kidney disease (CKD) aged ≥ 75 years.
METHODS AND RESULTS
From January 2008 to July 2014, we included 390 consecutive patients ≥ 75 years of age with ejection fraction ≤ 35% and glomerular filtration rate (GFR) ≤ 60 mL/min per 1.73 m. We analyzed the relationship between treatment with BB and mortality or cardiovascular events. The mean age of our population was 82.6 ± 4.1 years. Mean ejection fraction was 27.9% ± 6.5%. GFR was 60-45 mL/min per 1.73 m in 50.3% of patients, 45-30 mL/min per 1.73 m in 37.4%, and < 30 mL/min per 1.73 m in 12.3%. At the conclusion of follow-up, 67.4% of patients were receiving BB. The median follow-up was 28.04 (IR: 19.41-36.67) months. During the study period, 211 patients (54.1%) died and 257 (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). BB use was significantly associated with a reduced risk of death (HR = 0.51, 95% CI: 0.35-0.74; < 0.001). Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD: stage IIIa (GFR = 30-45 mL/min per 1.73 m ; HR = 0.47, 95% CI: 0.26-0.86, < 0.0001), stage IIIb (GFR 30-45 mL/min per 1.73 m ; HR = 0.55, 95% CI: 0.26-1.06, = 0.007), and stages IV and V (GFR < 30 mL/min per 1.73 m ; HR = 0.29, 95% CI: 0.11-0.76; = 0.047).
CONCLUSIONS
The use of BB in elderly patients with HFrEF and renal impairment was associated with a better prognosis. Use of BB should be encouraged when possible.
目的
评估β受体阻滞剂（BB）在年龄≥75岁的慢性肾脏病（CKD）患者中的作用。
方法与结果
2008年1月至2014年7月，我们纳入了390例年龄≥75岁、射血分数≤35%且肾小球滤过率（GFR）≤60 mL/（min·1.73 m²）的连续患者。我们分析了使用BB治疗与死亡率或心血管事件之间的关系。我们研究人群的平均年龄为82.6±4.1岁。平均射血分数为27.9%±6.5%。50.3%的患者GFR为60 - 45 mL/（min·1.73 m²），37.4%的患者为45 - 30 mL/（min·1.73 m²），12.3%的患者<30 mL/（min·1.73 m²）。随访结束时，67.4%的患者正在使用BB。中位随访时间为28.04（四分位间距：19.41 - 36.67）个月。在研究期间，211例患者（54.1%）死亡，257例（65.9%）发生了重大心血管事件（死亡或因心力衰竭住院）。使用BB与死亡风险降低显著相关（HR = 0.51，95%CI：0.35 - 0.74；P<0.001）。接受BB治疗的患者在CKD的不同阶段死亡风险持续降低：Ⅲa期（GFR = 30 - 45 mL/（min·1.73 m²）；HR = 0.47，95%CI：0.26 - 0.86，P<0.0001），Ⅲb期（GFR 30 - 45 mL/（min·1.73 m²）；HR = 0.55，95%CI：0.26 - 1.06，P = 0.007），以及Ⅳ期和Ⅴ期（GFR < 30 mL/（min·1.73 m²）；HR = 0.29，95%CI：0.11 - 0.76；P = 0.047）。
结论
在老年射血分数降低的心力衰竭（HFrEF）合并肾功能损害患者中使用BB与较好的预后相关。应尽可能鼓励使用BB。
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