诊断为晚期心力衰竭后肾功能的变化。
Changes in Kidney Function After Diagnosis of Advanced Heart Failure.
机构信息
Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
出版信息
J Card Fail. 2023 Dec;29(12):1617-1625. doi: 10.1016/j.cardfail.2023.06.021. Epub 2023 Jul 13.
BACKGROUND
Kidney function and its association with outcomes in patients with advanced heart failure (HF) has not been well-defined.
METHODS AND RESULTS
We conducted a retrospective cohort study comprising all adult residents of Olmsted County, Minnesota, with HF who developed advanced HF from 2007 to 2017. Patients were grouped by estimated glomerular filtration rate (eGFR) at advanced HF diagnosis using the 2021 Chronic Kidney Disease Epidemiology Collaboration equation. A linear mixed effects model was fitted to assess the relationship between development of advanced HF and longitudinal eGFR trajectory. A total of 936 patients with advanced HF (mean age 77 years, 55% male, 93.7% White) were included. Twenty-two percent of these patients had an eGFR of <30 at advanced HF diagnosis, 22% had an eGFR of 30-44, 23% had an eGFR of 45-59, and 32% had an eGFR of ≥60 mL/min/1.73 m. The eGFR decreased faster after advanced HF (7.6% vs 10.9% annual decline before vs after advanced HF), with greater decreases after advanced HF in those with diabetes and preserved ejection fraction. An eGFR of <30 mL/min/1.73 m was associated with worse survival after advanced HF compared with an eGFR of ≥60 mL/min/1.73 m (adjusted hazard ratio 1.30, 95% confidence interval 1.07-1.57).
CONCLUSIONS
eGFR deteriorated faster after patients developed advanced HF. An eGFR of <30 mL/min/1.73 m at advanced HF diagnosis was associated with higher mortality.
背景
肾功能及其与晚期心力衰竭（HF）患者结局的关系尚未明确。
方法和结果
我们进行了一项回顾性队列研究，纳入了 2007 年至 2017 年期间明尼苏达州奥姆斯特德县所有发展为晚期 HF 的成年 HF 患者。根据 2021 年慢性肾脏病流行病学合作研究方程，根据晚期 HF 诊断时的估算肾小球滤过率（eGFR）将患者分为不同组。采用线性混合效应模型评估晚期 HF 发展与纵向 eGFR 轨迹之间的关系。共纳入 936 例晚期 HF 患者（平均年龄 77 岁，55%为男性，93.7%为白人）。其中 22%的患者在晚期 HF 诊断时的 eGFR<30，22%的患者 eGFR 为 30-44，23%的患者 eGFR 为 45-59，32%的患者 eGFR≥60mL/min/1.73m。晚期 HF 后 eGFR 下降速度更快（7.6%vs. 10.9%，晚期 HF 前 vs. 后每年下降），糖尿病和射血分数保留患者的 eGFR 下降幅度更大。与 eGFR≥60mL/min/1.73m 相比，晚期 HF 时 eGFR<30mL/min/1.73m 与较差的生存相关（调整后的危险比 1.30，95%置信区间 1.07-1.57）。
结论
患者发展为晚期 HF 后，eGFR 恶化速度更快。晚期 HF 诊断时 eGFR<30mL/min/1.73m 与更高的死亡率相关。
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