Alcázar Roberto, Escobar Carlos, Palacios Beatriz, Aranda Unai, Varela Luis, Capel Margarita, Sicras Antoni, Sicras Aram, Hormigo Antonio, Manito Nicolás, Botana Manuel
University Hospital Infanta Leonor, Madrid, Spain.
University Hospital La Paz, Madrid, Spain.
Clin Kidney J. 2022 Mar 5;15(7):1415-1424. doi: 10.1093/ckj/sfac066. eCollection 2022 Jul.
To assess mortality and cardiovascular and renal outcomes among patients with chronic kidney disease (CKD) (primary objective), with a particular focus on heart failure (HF) risk following diagnosis of CKD (secondary objective) in Spain.
We conducted an observational study comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic health records. For the primary objective, adults with prevalent CKD [estimated glomerular filtration rate (eGFR) <60 or ≥60 mL/min/1.73 m with a urine albumin:creatinine ratio (UACR) ≥30 mg/g at the index date (1 January 2017)] were included. For the secondary objective, adults with incident CKD in 2017 were enrolled.
In the prevalent population, 46 786 patients with CKD without HF [75.8 ± 14.4 years, eGFR 51.4 ± 10.1 mL/min/1.73 m; 75.1% on renin-angiotensin system inhibitors (RASis)] and 8391 with CKD and HF (79.4 ± 10.9 years, eGFR 46.4 ± 9.8 mL/min/1.73 m) were included. In the prevalent population, the risk of all-cause death {hazard ratio [HR] 1.107 [95% confidence interval (CI) 1.064-1.153]}, HF hospitalization [HR 1.439 (95% CI 1.387-1.493)] and UACR progression [HR 1.323 (95% CI 1.182-1.481)] was greater in those patients with CKD and HF versus CKD only. For the incident population, 1594 patients with CKD without HF and 727 with CKD and HF were included. Within 24 months from the CKD diagnosis (with/without HF at baseline), 6.5% of patients developed their first HF hospitalization. Although 60.7% were taking RASis, only 3.4% were at maximal doses and among diabetics, 1.3% were taking sodium-glucose cotransporter-2 inhibitors.
The presence of HF among CKD patients markedly increases the risk of outcomes. CKD patients have a high risk of HF, which could be partially related to insufficient treatment.
评估西班牙慢性肾脏病（CKD）患者的死亡率、心血管和肾脏结局（主要目标），特别关注CKD诊断后的心力衰竭（HF）风险（次要目标）。
我们进行了一项观察性研究，包括使用电子健康记录中的二手数据进行横断面和纵向回顾性分析。对于主要目标，纳入在索引日期（2017年1月1日）患有CKD的成年人[估计肾小球滤过率（eGFR）<60或≥60 mL/min/1.73 m²且尿白蛋白：肌酐比值（UACR）≥30 mg/g]。对于次要目标，纳入2017年新发CKD的成年人。
在现患人群中，纳入了46786例无HF的CKD患者[75.8±14.4岁，eGFR 51.4±10.1 mL/min/1.73 m²；75.1%使用肾素-血管紧张素系统抑制剂（RASis）]和8391例患有CKD且合并HF的患者（79.4±10.9岁，eGFR 46.4±9.8 mL/min/1.73 m²）。在现患人群中，与仅患有CKD的患者相比，患有CKD且合并HF的患者全因死亡风险{风险比[HR] 1.107 [95%置信区间（CI）1.064 - 1.153]}、HF住院风险[HR 1.439（95% CI 1.387 - 1.493）]和UACR进展风险[HR 1.323（95% CI 1.182 - 1.481）]更高。对于新发病例人群，纳入了1594例无HF的CKD患者和727例患有CKD且合并HF的患者。在CKD诊断后的24个月内（基线时有无HF），6.5%的患者首次发生HF住院。尽管60.7%的患者正在使用RASis，但只有3.4%的患者使用最大剂量，在糖尿病患者中，1.3%的患者正在使用钠-葡萄糖协同转运蛋白2抑制剂。
CKD患者中HF的存在显著增加了不良结局的风险。CKD患者发生HF的风险很高，这可能部分与治疗不足有关。
