Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Faculty of Medicine, Yamagata University School of Medicine, Yamagata, Japan.
ESC Heart Fail. 2023 Aug;10(4):2458-2468. doi: 10.1002/ehf2.14378. Epub 2023 Jun 1.
Despite advances in heart failure (HF) treatment, HF with preserved ejection fraction (HFpEF) remains a health problem with a high mortality rate. HFpEF is composed of diverse phenogroups, of which patients with concomitant renal impairment have worse outcomes. Renal tubular damage (RTD) is associated with the development of HF and chronic kidney disease (CKD). However, the impact of RTD on HF progression in patients with HFpEF and CKD remains unclear. The aim of the present study was to examine whether RTD could predict HF-related events in patients with HFpEF and CKD.
We measured RTD markers, such as urinary β -microglobulin to creatinine ratio (UBCR) and N-acetyl-β-d-glucosamidase (NAG) level, in 319 consecutive patients with HFpEF and CKD who were hospitalized for acute HF (49% females, mean age 76 ± 12). Based on previous reports, high UBCR and high NAG levels were defined as UBCR ≥300 μg/gCr and NAG >14.2 U/gCr, respectively. There were 91 HF-related events, defined as HF hospitalizations or HF deaths, during the median follow-up period of 5.2 years. The prevalence of high UBCR increased with advancing New York Heart Association functional class and albuminuria. Kaplan-Meier analysis demonstrated that patients with high UBCR had more HF-related events than those with normal or low UBCR. Multivariate Cox proportional hazards regression analyses demonstrated that high UBCR, but not high NAG level, was an independent predictor of HF-related events after adjusting for confounding risk factors in patients with HFpEF and CKD (hazard ratio, 2.60; 95% confidence interval, 1.52-4.72; P = 0.0009). UBCR significantly improved the C-statistic, with a significant net reclassification index and integrated discrimination improvement (0.738 vs. 0.684; P = 0.0244).
RTD, as assessed by a high UBCR, was associated with the severity and clinical outcomes of HFpEF and CKD, indicating that it could be a feasible marker for HF progression.
尽管心力衰竭（HF）的治疗取得了进展，但射血分数保留的心力衰竭（HFpEF）仍然是一个死亡率较高的健康问题。HFpEF 由多种表型组成，其中合并肾功能损害的患者预后更差。肾小管损伤（RTD）与 HF 和慢性肾脏病（CKD）的发展有关。然而，RTD 对 HFpEF 和 CKD 患者 HF 进展的影响尚不清楚。本研究旨在探讨 RTD 是否可以预测 HFpEF 和 CKD 患者的 HF 相关事件。
我们测量了 319 例连续住院的 HFpEF 和 CKD 急性 HF 患者（49%为女性，平均年龄 76±12 岁）的 RTD 标志物，如尿β-微球蛋白与肌酐比值（UBCR）和 N-乙酰-β-D-氨基葡萄糖苷酶（NAG）水平。根据以往的报告，高 UBCR 和高 NAG 水平分别定义为 UBCR≥300μg/gCr 和 NAG＞14.2U/gCr。在中位随访 5.2 年期间，有 91 例 HF 相关事件，定义为 HF 住院或 HF 死亡。随着纽约心脏协会（NYHA）功能分级和白蛋白尿的进展，高 UBCR 的患病率增加。Kaplan-Meier 分析表明，高 UBCR 组的 HF 相关事件发生率高于正常或低 UBCR 组。多变量 Cox 比例风险回归分析表明，在校正 HFpEF 和 CKD 患者的混杂危险因素后，高 UBCR 而不是高 NAG 水平是 HF 相关事件的独立预测因素（风险比，2.60；95%置信区间，1.52-4.72；P=0.0009）。UBCR 显著提高了 C 统计量，具有显著的净重新分类指数和综合判别改善（0.738 与 0.684；P=0.0244）。
RTD 作为 UBCR 的一个指标，与 HFpEF 和 CKD 的严重程度和临床结局相关，表明它可能是 HF 进展的一个可行标志物。
