Sun Yu-Qing, Luo Lei-Ming, Wang Zhi-Yan, Lv Qiang, Du Xin, Dong Jian-Zeng
Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung & Blood Vessel Diseases, Capital Medical University, No, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Department of Cardiology, First Medical Center of PLA General Hospital, Beijing, China.
J Cardiothorac Surg. 2025 Jul 9;20(1):291. doi: 10.1186/s13019-025-03527-2.
The aim of this study is to analyze the distinct characteristics and risk factors contributing to the development of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF), while also examining the subset of persistent WRF among elderly patients with ADHF.
In this retrospective study, patients were stratified into two groups, non-WRF and WRF, based on alterations in creatinine levels. Subsequently, the WRF group was further delineated into transient and persistent WRF subgroups, contingent upon temporal changes in creatinine levels. There 218 elderly ADHF patients aged ≥ 60 years old, with an average age of (72.11 ± 7.94) years old. Among them, 66 patients with ADHF developed WRF during hospitalization, with an incidence of 30.28%. Among the 66 WRF patients, 20 cases were transient WRF and 46 cases were persistent WRF. The study revealed notable distinctions within the WRF cohort, characterized by heightened smoking prevalence, significantly elevated brain natriuretic peptide (BNP) levels at admission, diminished hematocrit (HCT) levels and more applications. ACEI (angiotensin-converting enzyme inhibitors) or ARB (angiotensin receptor inhibitor) or ARNI (angiotensin receptor neprilysin inhibitor) drugs. Within the persistent WRF subgroup, patients were characterized by advanced age, predominantly male gender distribution, heightened incidence of coronary artery disease, and significantly elevated systolic blood pressure (SBP), uric acid, BNP, and glycosylated hemoglobin levels compared to their transient WRF counterparts, while displaying lower D-dimer levels. In multivariate analysis, BNP level (OR = 1.001, 95%CI 1.000-1.001; = 0.032), D-dimer level (OR = 1.013, 95%CI 1.003–1.024; = 0.013), ACEI or ARB or ARNI drugs (OR = 19.656, 95%CI 8.698–30.763; = 0.009) were positively correlated with the occurrence of WRF. HCT level was negatively correlated with the occurrence of WRF (OR = 0.850, 95%CI 0.744–0.970; = 0.016). Systolic blood pressure (OR = 1.158, 95%CI 1.051–1.276; = 0.003), D-dimer levels (OR = 0.998, 95%CI 0.997–0.999; < 0.001) were associated with persistent WRF.
The findings of this study indicate a clear association between BNP, HCT, D-dimer levels and ACEI or ARB or ARNI drugs and the emergence of WRF in elderly individuals with ADHF. Furthermore, the study underscores that persistent WRF is notably linked with systolic blood pressure and D-dimer levels.
本研究旨在分析急性失代偿性心力衰竭（ADHF）老年患者肾功能恶化（WRF）发生发展的独特特征和危险因素，同时研究ADHF老年患者中持续性WRF的亚组情况。
在这项回顾性研究中，根据肌酐水平变化将患者分为非WRF和WRF两组。随后，根据肌酐水平的时间变化，将WRF组进一步分为短暂性和持续性WRF亚组。共有218例年龄≥60岁的老年ADHF患者，平均年龄为（72.11±7.94）岁。其中，66例ADHF患者在住院期间出现WRF，发生率为30.28%。在这66例WRF患者中，20例为短暂性WRF，46例为持续性WRF。研究发现WRF队列中有显著差异，表现为吸烟率升高、入院时脑钠肽（BNP）水平显著升高、血细胞比容（HCT）水平降低以及更多地应用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体抑制剂（ARB）或血管紧张素受体脑啡肽酶抑制剂（ARNI）药物。在持续性WRF亚组中，患者的特点是年龄较大、男性占主导、冠状动脉疾病发生率较高，与短暂性WRF患者相比，收缩压（SBP）、尿酸、BNP和糖化血红蛋白水平显著升高，而D-二聚体水平较低。多因素分析显示，BNP水平（OR = 1.001，95%CI 1.000 - 1.001；P = 0.032）、D-二聚体水平（OR = 1.013，95%CI 1.003 - 1.024；P = 0.013）、ACEI或ARB或ARNI药物（OR = 19.656，95%CI 8.698 - 30.763；P = 0.009）与WRF的发生呈正相关。HCT水平与WRF的发生呈负相关（OR = 0.850，95%CI 0.744 - 0.970；P = 0.016）。收缩压（OR = 1.158，95%CI 1.051 - 1.276；P = 0.003）、D-二聚体水平（OR = 0.998，95%CI 0.997 - 0.999；P < 0.001）与持续性WRF有关。
本研究结果表明，BNP、HCT、D-二聚体水平以及ACEI或ARB或ARNI药物与ADHF老年个体中WRF的出现存在明显关联。此外，研究强调持续性WRF与收缩压和D-二聚体水平显著相关。
