Kim Jin Sug, Kim Weon, Lee Hyo-Jin, Jeong Kyung Hwan, Jeong Su Jin, Jeong Myung Ho, Hwang Jin-Yong, Hur Seung Ho, Hwang Hyeon Seok
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Sci Rep. 2025 Jul 1;15(1):21517. doi: 10.1038/s41598-025-07768-y.
The potential interaction between the heart and kidneys is thought to contribute to the development of renal hyperfiltration (RHF). However, the clinical implications of RHF remain unclear in patients with acute myocardial infarction (AMI). A total of 9561 AMI patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m were enrolled from a large nationwide cohort. RHF was defined as eGFR > 90th percentile after multiple adjustments. The primary endpoint was a combination of 3 year major adverse cardiovascular events (MACEs) after AMI treatment. The cumulative event rate of MACEs was significantly higher in patients with RHF. In multivariable Cox-regression analysis, RHF increased the 1.34-fold risk of MACE (95% confidence interval [CI] 1.12-1.62) compared to those without RHF. Patients with RHF had a significantly higher risk of all-cause mortality (hazard ratio [HR] 1.64; 95% CI 1.25-2.14) and cardiac death (HR 1.78; 95% CI 1.26-2.51). There was a U-shaped association between the adjusted risk of MACEs and eGFR, with the risk increasing as eGFR exceeded approximately 100 mL/min/1.73 m. The results demonstrated a consistent pattern in the 1:1 PS-matched population. Our study offers new insights into the risk stratification of AMI patients with RHF.
心脏和肾脏之间的潜在相互作用被认为会导致肾高滤过(RHF)的发生。然而,RHF在急性心肌梗死(AMI)患者中的临床意义仍不明确。从一个大型全国性队列中纳入了9561例估计肾小球滤过率(eGFR)≥60 mL/min/1.73 m²的AMI患者。RHF被定义为在多次调整后eGFR超过第90百分位数。主要终点是AMI治疗后3年主要不良心血管事件(MACE)的复合终点。RHF患者的MACE累积事件发生率显著更高。在多变量Cox回归分析中,与无RHF的患者相比,RHF使MACE风险增加了1.34倍(95%置信区间[CI] 1.12 - 1.62)。RHF患者的全因死亡率(风险比[HR] 1.64;95% CI 1.25 - 2.14)和心源性死亡风险(HR 1.78;95% CI 1.26 - 2.51)显著更高。调整后的MACE风险与eGFR之间存在U型关联,随着eGFR超过约100 mL/min/1.73 m²,风险增加。结果在1:1倾向评分匹配人群中呈现出一致的模式。我们的研究为RHF的AMI患者的风险分层提供了新的见解。