Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Rheumatology, Pneumology) & Transplant Center Mannheim, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
Clin Res Cardiol. 2024 Nov;113(11):1565-1575. doi: 10.1007/s00392-024-02453-y. Epub 2024 May 6.
The study investigates the prognostic impact of the severity and etiology of chronic kidney disease (CKD) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).
Data regarding the outcomes in patients with CKD in HFmrEF is scarce.
Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Prognosis of patients with different stages and etiologies of CKD was investigated with regard to the primary endpoint of all-cause mortality at 30 months.
A total of 2155 consecutive patients with HFmrEF were included with an overall prevalence of CKD of 31%. Even milder stages of CKD (i.e., KDIGO stage 3a) were associated with an increased risk of 30-months all-cause mortality (HR = 1.242; 95% CI 1.147-1.346; p = 0.001). However, long-term prognosis did not differ in patients with KDIGO stage 5 compared to patients with stage 4 (HR = 0.886; 95% CI 0.616-1.275; p = 0.515). Furthermore, the highest risk of HF-related rehospitalization was observed in patients with KDIGO stages 3b and 4 (log rank p ≤ 0.015), whereas patients with KDIGO stage 5 had a lower risk of HF-related rehospitalization compared to patients with KDIGO stage 4 (HR = 0.440; 95% CI 0.228-0.849; p = 0.014). In contrast, the etiology of CKD was not associated with the risk of 30-month all-cause mortality (log rank p ≥ 0.347) and HF-related rehospitalization (log rank p ≥ 0.149).
In patients with HFmrEF, even milder stages of CKD were independently associated with increased risk of 30-months all-cause mortality.
本研究旨在探讨慢性肾脏病（CKD）严重程度和病因对射血分数轻度降低的心力衰竭（HFmrEF）患者预后的影响。
目前有关 HFmrEF 患者 CKD 结局的数据较为缺乏。
回顾性纳入 2016 年至 2022 年在一家机构就诊的连续 HFmrEF 患者。根据 30 个月时全因死亡率这一主要终点，研究不同 CKD 分期和病因患者的预后。
共纳入 2155 例连续 HFmrEF 患者，CKD 的总体患病率为 31%。即使是更轻度的 CKD 分期（即 KDIGO 3a 期）也与 30 个月全因死亡率增加相关（HR=1.242；95%CI 1.147-1.346；p=0.001）。然而，与 CKD 4 期患者相比，KDIGO 5 期患者的长期预后并无差异（HR=0.886；95%CI 0.616-1.275；p=0.515）。此外，在 KDIGO 3b 和 4 期患者中观察到心力衰竭相关再住院的风险最高（log rank p≤0.015），而与 CKD 4 期患者相比，KDIGO 5 期患者心力衰竭相关再住院的风险较低（HR=0.440；95%CI 0.228-0.849；p=0.014）。相比之下，CKD 的病因与 30 个月全因死亡率（log rank p≥0.347）和心力衰竭相关再住院率（log rank p≥0.149）无相关性。
在 HFmrEF 患者中，即使是更轻度的 CKD 分期也与 30 个月全因死亡率增加独立相关。
