肾脏体积对急性心力衰竭患者院内肾脏相关不良结局发生率的影响

Impact of kidney volume on incidence of in-hospital kidney-related adverse outcomes in patients with acute heart failure.

作者信息

Saito Akira, Asano Taku, Komiyama Nobuyuki, Ohde Sachiko

机构信息

Department of Cardiology, St. Luke's International University, Tokyo, Japan.

Graduate School of Public Health, St Luke's International University, Tokyo, Japan.

出版信息

BMC Cardiovasc Disord. 2025 Jan 28;25(1):60. doi: 10.1186/s12872-025-04502-4.

DOI:10.1186/s12872-025-04502-4

PMID:39875830

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11776214/

Abstract

BACKGROUND

Recent studies revealed an association between small kidney volume and progression of kidney dysfunction in particular settings such as kidney transplantation and transcatheter aortic valve implantation. We hypothesized that kidney volume was associated with the incidence of kidney-related adverse outcomes such as worsening renal function (WRF) in patients with acute heart failure (AHF).

METHODS

This study was a single-center retrospective cohort study. It included patients admitted for AHF treatment between 2011 and 2021 and who underwent computed tomography (CT) that included images of the kidneys on the date of admission. We measured the volume of the right and left kidneys using dedicated volume analyzing software for 3D-CT (SYNAPSE VINCENT, Fuji Film, Tokyo, Japan) and determined the total kidney volume by adding the volumes of the left and right kidneys. We defined the composite of death from any cause, initiating renal replacement therapy, and WRF during hospitalization as major adverse kidney events (MAKE). We conducted multivariate logistic regression analysis to evaluate the impact of MAKE and each component of MAKE adjusted for age, sex, body surface area, estimated Glomerular Filtration Rate (eGFR) on admission date and the factors that were significantly associated with the incidence of MAKE by bivariate analysis.

RESULTS

In the 229 patients enrolled in the analysis, death from any cause, initiating RRT, and WRF occurred in 30 (13.1%), 10 (4.4%), and 85 (37.3%) patients, respectively. It was found that small kidney volume (≤ 250 ml) was independently associated with the increased incidence of MAKE (odds ratio 3.92, 95% confidence interval [1.18-13.08], p = 0.026) and WRF (odds ratio 6.58, 95%confidence interval [1.85-23.42] p = 0.004). The area under the receiver operating characteristic curve for multivariate logistic regression analysis of MAKE was 0.71.

CONCLUSIONS

Kidney volume on admission was independently associated with the increased incidence of kidney-related adverse outcomes during hospitalization in patients with AHF.

摘要

背景

最近的研究揭示了在肾移植和经导管主动脉瓣植入等特定情况下，小肾脏体积与肾功能障碍进展之间的关联。我们假设在急性心力衰竭（AHF）患者中，肾脏体积与肾脏相关不良结局的发生率相关，如肾功能恶化（WRF）。

方法

本研究为单中心回顾性队列研究。纳入2011年至2021年间因AHF治疗入院且在入院当天接受了包括肾脏图像的计算机断层扫描（CT）的患者。我们使用专门的3D-CT体积分析软件（SYNAPSE VINCENT，富士胶片，日本东京）测量左右肾脏的体积，并通过将左右肾脏的体积相加来确定总肾脏体积。我们将任何原因导致的死亡、开始肾脏替代治疗以及住院期间的WRF合并定义为主要不良肾脏事件（MAKE）。我们进行多因素逻辑回归分析，以评估MAKE及其各组成部分在调整年龄、性别、体表面积、入院日期的估计肾小球滤过率（eGFR）以及通过双变量分析与MAKE发生率显著相关的因素后的影响。

结果

在纳入分析的229例患者中，任何原因导致的死亡、开始RRT和WRF分别发生在30例（13.1%）、10例（4.4%）和85例（37.3%）患者中。发现小肾脏体积（≤250 ml）与MAKE发生率增加独立相关（比值比3.92，95%置信区间[1.18 - 13.08]，p = 0.026）以及WRF（比值比6.58，95%置信区间[1.85 - 23.42]，p = 0.004）。MAKE多因素逻辑回归分析的受试者工作特征曲线下面积为0.71。