Iwanek Gracjan, Ponikowska Barbara, Salah Husam, Fudim Marat, Guzik Mateusz, Zymliński Robert, Aleksandrowicz Krzysztof, Ponikowska Beata, Biegus Jan
Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wrocław, Poland.
Student Scientific Organization, Wroclaw Medical University, 50-367 Wrocław, Poland.
J Clin Med. 2024 Dec 20;13(24):7796. doi: 10.3390/jcm13247796.
: Despite the prevalence of impaired renal function in acute heart failure (AHF) patients, the intricate relationship between glomerular, tubular, and metabolic renal function remains unexplored. We aimed to investigate the co-occurrence of glomerular, tubular, and metabolic renal dysfunction in AHF and their impact on prognosis. : eGFR, spot urine sodium, and HCO were measured in 243 patients hospitalized for AHF. The population was stratified by the 4-point renal dysfunction score and linked with outcomes. : Glomerular dysfunction exhibited an elevated risk of death (HR of 2.04; 95% CI [1.24-3.36]; = 0.006), combined risk of death, and HF rehospitalization (HR of 2.03; 95% CI [1.34-3.05]; = 0.005). Similarly, tubular dysfunction correlated with a higher death risk (HR of 1.72; 95% CI [1.04-2.82]; = 0.03) and a higher combined risk (HR of 1.82; 95% CI [1.21-2.74]; = 0.004). While renal metabolic dysfunction was linked to increased death risk (HR of 1.82; 95% CI [1.07-3.11]; = 0.028), it was not associated with composite risk (HR of 1.37; 95% CI [0.88-2.15]; = 0.174). Multivariate analysis revealed a direct association between the renal dysfunction score and death risk (HR of 1.92 per 1 point; 95% CI [1.47-2.52]; < 0.0001) and the combined risk of death and HF rehospitalization (HR of 1.78 per 1 point; 95% CI [1.43-2.22]; < 0.0001). : Renal dysfunction is common, with varied overlaps. Glomerular, tubular, and metabolic dysfunctions predict adverse outcomes in AHF. The established renal score may aid patient stratification and prognosis.
尽管急性心力衰竭（AHF）患者中肾功能受损普遍存在，但肾小球、肾小管和代谢性肾功能之间的复杂关系仍未得到探索。我们旨在研究AHF患者中肾小球、肾小管和代谢性肾功能障碍的共同发生情况及其对预后的影响。对243例因AHF住院的患者测量了估算肾小球滤过率（eGFR）、随机尿钠和碳酸氢根。根据4分肾功能障碍评分对人群进行分层，并与预后相关联。肾小球功能障碍显示死亡风险升高（风险比[HR]为2.04；95%置信区间[CI][1.24 - 3.36]；P = 0.006）、死亡和心力衰竭再住院的综合风险升高（HR为2.03；95% CI[1.34 - 3.05]；P = 0.005）。同样，肾小管功能障碍与更高的死亡风险（HR为1.72；95% CI[1.04 - 2.82]；P = 0.03）和更高的综合风险（HR为1.82；95% CI[1.21 - 2.74]；P = 0.004）相关。虽然肾代谢功能障碍与死亡风险增加相关（HR为1.82；95% CI[1.07 - 3.11]；P = 0.028），但与综合风险无关（HR为1.37；95% CI[0.88 - 2.15]；P = 0.174）。多变量分析显示肾功能障碍评分与死亡风险（每1分HR为1.92；95% CI[1.47 - 2.52]；P < 0.0001）以及死亡和心力衰竭再住院的综合风险（每1分HR为1.78；95% CI[1.43 - 2.22]；P < 0.0001）之间存在直接关联。肾功能障碍很常见，存在多种重叠情况。肾小球、肾小管和代谢功能障碍可预测AHF患者的不良预后。已建立的肾功能评分可能有助于患者分层和预后评估。
