Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.
PLoS One. 2021 Oct 28;16(10):e0258949. doi: 10.1371/journal.pone.0258949. eCollection 2021.
Impaired renal function is a major contributor to the low proportion of mineralocorticoid receptor antagonist (MRA) treatment in patients with heart failure with reduced ejection fraction (HFrEF). Our aims were to investigate the impact of MRA treatment on all-cause mortality and worsening renal function (WRF) in patients with HFrEF and moderately impaired renal function.
Retrospective data between 2010-2018 on HFrEF patients from a single-centre hospital with estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR ≥ 20%.
416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77 years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128 patients (32%) experienced WRF, 25% in the MRA group and 30% in patients without MRA (p = 0.293). In multivariable analysis, hospitalization for heart failure and systolic blood pressure were associated with WRF (p = 0.015 and p = <0.001), but not use of MRA (p = 0.421). MRA treatment had no impact on the risk of adjusted all-cause mortality (HR 0.93; 95% CI, 0.66-1.32 p = 0.685). WRF was associated with increased adjusted risk of all-cause mortality (HR 1.43; 95% CI, 1.07-1.89 p = 0.014). Use of MRA did not increase the adjusted overall risk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81-1.63 p = 0.422).
In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA did not increase risk for WRF or all-cause mortality.
肾功能受损是心力衰竭伴射血分数降低（HFrEF）患者中醛固酮受体拮抗剂（MRA）治疗比例较低的主要原因。我们的目的是研究 MRA 治疗对伴有中度肾功能受损的 HFrEF 患者的全因死亡率和肾功能恶化（WRF）的影响。
回顾性分析了 2010 年至 2018 年期间，一家单中心医院的 HFrEF 患者的资料，这些患者的估计肾小球滤过率（eGFR）<60ml/min/1.73m2。WRF 定义为 eGFR 下降≥20%。
共纳入 416 例患者，其中 131 例接受 MRA 治疗，285 例未接受 MRA 治疗，平均年龄为 77 岁（标准差±9）和 82 岁（标准差±9），中位随访时间为 2 年。128 例（32%）发生 WRF，MRA 组为 25%，未用 MRA 组为 30%（p=0.293）。多变量分析显示，心力衰竭住院和收缩压与 WRF 相关（p=0.015 和 p<0.001），但与 MRA 的使用无关（p=0.421）。MRA 治疗对调整后的全因死亡率无影响（HR 0.93；95%CI，0.66-1.32，p=0.685）。WRF 与调整后的全因死亡率增加相关（HR 1.43；95%CI，1.07-1.89，p=0.014）。即使发生 WRF，MRA 的使用也不会增加调整后的总死亡率风险（HR 1.15；95%CI，0.81-1.63，p=0.422）。
在这组伴有中度肾功能受损的老年 HFrEF 患者中，MRA 不会增加 WRF 或全因死亡率的风险。
