Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Clin Cardiol. 2023 Jan;46(1):57-66. doi: 10.1002/clc.23934. Epub 2022 Nov 7.
The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ.
Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF).
A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFR ) and predischarge (eGFR ). Clinical outcomes were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization.
During an average 2.6 ± 3.2 years follow-up, 66 patients (55%) experienced 4P-MACE. Patients with impaired eGFR (<60 ml/min/1.73 m ) had more 4P-MACE than those with preserved eGFR (64.7% vs. 43.1%, p = .019). The Kaplan-Meier survival curves showed significantly higher incidence of 4P-MACE in patients with impaired eGFR than those with preserved eGFR (p = .002). Cox regression analysis revealed that impaired eGFR was significantly correlated with the development of 4P-MACE (hazard ratio, 2.003; 95% confidence interval, 1.072-3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization.
Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.
心脏和肾脏之间存在双向相互作用，心脏或肾脏的功能障碍可导致另一个器官的功能障碍。
急性失代偿性心力衰竭（ADHF）患者住院期间肾功能及其下降可能对心血管结局有影响。
共前瞻性纳入 119 例连续因 ADHF 入院的中国患者。通过改良肾脏病饮食研究（MDRD）提出的四变量方程估算肾小球滤过率（eGFR）来表示肾功能的变化。肾功能恶化（WRF）定义为入院时（eGFR ）和出院前（eGFR ）之间的 eGFR 下降。临床结局定义为 4P-主要不良心血管事件（4P-MACE），包括心血管死亡、非致死性心肌梗死、非致死性卒中和非致死性 HF 住院的组成。
在平均 2.6±3.2 年的随访期间，66 例患者（55%）发生了 4P-MACE。eGFR 受损（<60ml/min/1.73m ）的患者发生 4P-MACE 的比例高于 eGFR 正常的患者（64.7% vs. 43.1%，p=0.019）。Kaplan-Meier 生存曲线显示，eGFR 受损患者发生 4P-MACE 的发生率明显高于 eGFR 正常的患者（p=0.002）。Cox 回归分析显示，eGFR 受损与 4P-MACE 的发生显著相关（风险比，2.003；95%置信区间，1.072-3.744；p=0.029）。相反，入院时 eGFR 和住院期间 eGFR 下降的结果相似。
出院时肾功能受损，而不是入院时或 WRF 时的肾功能受损，是 ADHF 患者预后不良的重要危险因素。
