慢性肾脏病患者射血分数保留型和降低型心力衰竭的相关危险因素和结局。
Risk Factors and Outcomes Associated With Heart Failure With Preserved and Reduced Ejection Fraction in People With Chronic Kidney Disease.
机构信息
Division of Nephrology, University of Washington, Seattle (N.B., L.Z.).
Kidney Health Research Collaborative, University of California, San Francisco (R.S., M.E., M.S.).
出版信息
Circ Heart Fail. 2024 May;17(5):e011173. doi: 10.1161/CIRCHEARTFAILURE.123.011173. Epub 2024 May 14.
BACKGROUND
Heart failure (HF) is associated with poor outcomes in people with chronic kidney disease, yet it is unknown whether outcomes differ by HF subtype. This study aimed to examine associations of incident HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF) with progression to end-stage kidney disease (ESKD) and mortality.
METHODS
We studied individuals with chronic kidney disease in the CRIC study (Chronic Renal Insufficiency Cohort) who were free of HF at cohort entry. Incident HF hospitalizations were adjudicated and classified into HFpEF (ejection fraction, ≥50%) or HFrEF (ejection fraction, <50%) based on echocardiograms performed during the hospitalization or at a research study visit. ESKD was defined as need for chronic dialysis or kidney transplant. Cox proportional hazards were used to evaluate the association of time-updated HF subtype with risk of ESKD and mortality, adjusting for demographics, comorbidities, and medication use.
RESULTS
Among the 3557 study participants without HF at cohort entry, mean age was 57 years and mean estimated glomerular filtration rate was 45 mL/min per 1.73 m. A total of 682 participants had incident HF. Incidence rates for HFpEF and HFrEF were 0.9 (95% CI, 0.8-1.0) and 0.7 (95% CI, 0.6-0.8) per 100 person-years, respectively (=0.005). Associations of incident HF with progression to ESKD were not statistically different for HFpEF (hazard ratio, 2.06 [95% CI, 1.66-2.56]) and HFrEF (hazard ratio, 1.80 [95% CI, 1.36-2.38]; =0.42). The associations with mortality were stronger for HFrEF (hazard ratio, 2.73 [95% CI, 2.24-3.33]) compared with HFpEF (hazard ratio, 1.99 [95% CI, 1.65-2.40]; =0.0002).
CONCLUSIONS
In a chronic kidney disease population, the rates of HFpEF hospitalizations were greater than that of HFrEF. Risk of ESKD was high but not statically different across HF subtypes. There was a stronger association of HFrEF with mortality. Prevention and treatment of both HFpEF and HFrEF should be central priorities to improve outcomes in chronic kidney disease.
背景
心力衰竭（HF）与慢性肾脏病患者的不良结局相关，但HF 亚组的结局是否不同尚不清楚。本研究旨在探讨射血分数保留型心力衰竭（HFpEF）与射血分数降低型心力衰竭（HFrEF）与进展至终末期肾病（ESKD）和死亡的相关性。
方法
我们研究了 CRIC 研究（慢性肾功能不全队列）中慢性肾脏病患者，这些患者在入组时无 HF。通过在住院期间或研究就诊期间进行的超声心动图检查，对 HF 住院患者进行 HFpEF（射血分数≥50%）或 HFrEF（射血分数<50%）的判定和分类。ESKD 的定义为需要慢性透析或肾移植。Cox 比例风险用于评估时间更新的 HF 亚组与 ESKD 和死亡率的风险关联，调整了人口统计学、合并症和药物使用情况。
结果
在没有 HF 的 3557 名研究参与者中，平均年龄为 57 岁，平均估计肾小球滤过率为 45 mL/min/1.73m。共有 682 名参与者发生 HF。HFpEF 和 HFrEF 的发生率分别为 0.9（95%CI，0.8-1.0）和 0.7（95%CI，0.6-0.8）/100 人年（=0.005）。HFpEF（风险比，2.06[95%CI，1.66-2.56]）和 HFrEF（风险比，1.80[95%CI，1.36-2.38]；=0.42）与 ESKD 进展的相关性无统计学差异。与 HFpEF（风险比，1.99[95%CI，1.65-2.40]）相比，HFrEF 与死亡率的相关性更强（风险比，2.73[95%CI，2.24-3.33]；=0.0002）。
结论
在慢性肾脏病患者中，HFpEF 住院率高于 HFrEF。HF 亚组的 ESKD 风险较高，但无统计学差异。HFrEF 与死亡率的相关性更强。预防和治疗 HFpEF 和 HFrEF 应成为改善慢性肾脏病患者结局的核心重点。
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