肾脏病对心力衰竭患者的患病率、临床特征和预后影响：哥伦比亚心力衰竭注册研究的观察性研究。
Prevalence, Clinical Characteristics, and Prognostic Impact of Kidney Disease on Heart Failure Patients: An Observational Study of the Colombian Heart Failure Registry.
机构信息
Cardiology Department, Fundación Valle del Lili, (Valle del Cauca), Cali, Colombia.
Cardiology Department, Clínica Cardio VID, (Antioquia), Medellín, Colombia.
出版信息
Cardiorenal Med. 2023;13(1):292-300. doi: 10.1159/000530852. Epub 2023 May 22.
INTRODUCTION
Chronic kidney disease (CKD) represents one of the most frequent comorbidities observed in heart failure (HF) patients and has been observed to increase this population's risk of adverse outcomes. Nevertheless, evidence analyzing kidney dysfunction in HF is scarce in Latin American populations. We aimed to analyze the prevalence of kidney dysfunction and assess its association with mortality in patients diagnosed with HF enrolled in the Colombian Heart Failure Registry (RECOLFACA).
METHODS
RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of the different categories of eGFR in mortality risk. A p value of <0.05 was considered significant. All statistical tests were two-tailed.
RESULTS
From the total 2,514 evaluated patients, 1,501 (59.7%) patients had moderate kidney dysfunction (eGFR <60 mL/min/1.73 m2), while 221 (8.8%) patients were classified as having a severe kidney dysfunction (eGFR <30 mL/min/1.73 m2). Patients with lower kidney function were most commonly males, had higher median age, and reported a higher prevalence of cardiovascular comorbidities. Moreover, different patterns of medications prescription were observed when comparing CKD versus non-CKD patients. Finally, eGFR <30 mL/min/1.73 m2 was significantly associated with a higher mortality risk compared to eGFR >90 mL/min/1.73 m2 status (HR: 1.87; 95% CI, 1.10-3.18), even after an extensive adjustment by relevant covariates.
CONCLUSION
CKD represents a prevalent condition in the setting of HF. Patients with CKD and HF present with multiple sociodemographic, clinical, and laboratory differences compared with those only diagnosed with HF and present a significantly higher risk of mortality. A timely diagnosis and optimal treatment and follow-up of CKD in the setting of HF may improve the prognosis of these patients and prevent adverse outcomes.
简介
慢性肾脏病（CKD）是心力衰竭（HF）患者最常见的合并症之一，并且已观察到它会增加该人群不良结局的风险。然而，在拉丁美洲人群中，关于 HF 患者肾功能障碍的证据仍然有限。我们旨在分析肾功能障碍的患病率，并评估其与在哥伦比亚心力衰竭注册（RECOLFACA）中诊断为 HF 的患者的死亡率之间的关系。
方法
RECOLFACA 在 2017 年至 2019 年期间从哥伦比亚的 60 个中心招募了患有 HF 诊断的成年患者。主要结局是全因死亡率。使用 Cox 比例风险回归模型评估不同 eGFR 类别对死亡率风险的影响。p 值<0.05 被认为具有统计学意义。所有统计检验均为双侧检验。
结果
在总共评估的 2514 名患者中，1501 名（59.7%）患者有中度肾功能障碍（eGFR <60 mL/min/1.73 m2），而 221 名（8.8%）患者被归类为严重肾功能障碍（eGFR <30 mL/min/1.73 m2）。肾功能较低的患者通常为男性，年龄中位数较高，并且报告有较高的心血管合并症患病率。此外，在比较 CKD 与非 CKD 患者时，观察到不同的药物处方模式。最后，与 eGFR >90 mL/min/1.73 m2 状态相比，eGFR <30 mL/min/1.73 m2 与更高的死亡率风险显著相关（HR：1.87；95%CI，1.10-3.18），即使在经过相关协变量的广泛调整后也是如此。
结论
CKD 在 HF 环境中是一种普遍存在的情况。与仅诊断为 HF 的患者相比，患有 CKD 和 HF 的患者具有多种社会人口统计学、临床和实验室差异，并且具有更高的死亡风险。及时诊断和优化 HF 患者的 CKD 治疗和随访可能会改善这些患者的预后并预防不良结局。
Zotero 插件