Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany.
Department of Internal Medicine II, Cardiology, Angiology and Pneumology, Klinikum Coburg GmbH, Coburg, Germany.
ESC Heart Fail. 2023 Oct;10(5):3011-3018. doi: 10.1002/ehf2.14387. Epub 2023 Aug 3.
Remote monitoring (RM) of thoracic impedance represents an early marker of pulmonary congestion in heart failure (HF). Chronic kidney disease (CKD) may promote fluid overload in HF patients. We investigated whether concomitant CKD affected the efficacy of impedance-based RM in the OptiLink HF trial.
Among HF patients included in the OptiLink HF trial, time to the first cardiovascular hospitalization and all-cause death according to the presence of concomitant CKD was analysed. CKD was defined as GFR < 60 mL/min/1.73 m at enrolment. Of the 1002 patients included in OptiLink HF, 326 patients (33%) had HF with concomitant CKD. The presence of CKD increased transmission of telemedical alerts (median of 2 (1-5) vs. 1 (0-3); P = 0.012). Appropriate contacting after alert transmission was equally low in patients with and without CKD (57% vs. 59%, P = 0.593). The risk of the primary endpoint was higher in patients with CKD compared with patients without CKD (hazard ratio (HR), 1.62 [95% confidence interval (CI), 1.16-2.28]; P = 0.005). Impedance-based RM independently reduced primary events in HF patients with preserved renal function, but not in those with CKD (HR 0.68 [95% CI, 0.52-0.89]; P = 0.006).
The presence of CKD in HF patients led to a higher number of telemedical alert transmissions and increased the risk of the primary endpoint. Inappropriate handling of alert transmission was commonly observed in patients with chronic HF and CKD. Guidance of HF management by impedance-based RM significantly decreased primary event rates in patients without CKD, but not in patients with CKD.
胸部阻抗的远程监测（RM）代表心力衰竭（HF）肺充血的早期标志物。慢性肾脏病（CKD）可能会导致 HF 患者液体超负荷。我们研究了同时存在 CKD 是否会影响基于阻抗的 RM 在 OptiLink HF 试验中的疗效。
在 OptiLink HF 试验中纳入的 HF 患者中，根据是否同时存在 CKD 分析了首次心血管住院和全因死亡的时间。CKD 的定义为入组时 GFR<60 mL/min/1.73 m。在 OptiLink HF 中纳入的 1002 例患者中，有 326 例（33%）患有伴有 CKD 的 HF。CKD 的存在增加了远程医疗警报的传输（中位数 2（1-5）与 1（0-3）；P=0.012）。在有和没有 CKD 的患者中，警报传输后适当联系的比例同样较低（分别为 57%和 59%，P=0.593）。与没有 CKD 的患者相比，有 CKD 的患者的主要终点风险更高（危险比（HR），1.62 [95%置信区间（CI），1.16-2.28]；P=0.005）。基于阻抗的 RM 可独立降低肾功能正常的 HF 患者的主要事件发生率，但不能降低 CKD 患者的主要事件发生率（HR 0.68 [95% CI，0.52-0.89]；P=0.006）。
HF 患者同时存在 CKD 会导致更多的远程医疗警报传输，并增加主要终点的风险。慢性 HF 和 CKD 患者中，警报传输的不当处理很常见。基于阻抗的 RM 指导 HF 管理可显著降低无 CKD 患者的主要事件发生率，但不能降低 CKD 患者的主要事件发生率。
