慢性肾脏疾病增加慢性心力衰竭患者死亡率

Chronic kidney disease is associated with increased mortality in patients with chronic heart failure

目的探讨慢性肾脏疾病(CKD)对慢性心力衰竭(CHF)患者死亡率的影响。方法对2007年1月1日至2009年12月31日在北京协和医院心内科住院,年龄≥21岁,临床诊断为心力衰竭,且左心室射血分数(LVEF)≤45%的缺血性(心肌梗死后至少40 d以上)或非缺血性心肌病患者进行回顾性研究,根据肾小球滤过率(eGFR)情况分为两组,一组为eGFR<60 ml.min-1.1.73 m-2(CKD组),另一组为eGFR≥60 ml.min-1.1.73 m-2(对照组),并进行电话随访。结果共筛选242例患者,除外41例不符合入选标准者,对201例进行随访,14例(7%)失访,经过2～41个月[平均(20±9)个月]的随访,共36例(19%)发生全因死亡,包括CKD组21例(30%)和对照组15例(13%)(P=0.003)。结论 CKD增加CHF患者死亡率。合并CKD的CHF患者,积极处理CHF的同时应高度重视CKD处理。

Objective To study the influence of chronic kidney disease （CKD） on mortality in patients with chronic heart failure （CHF）. Methods Ischemic （at least 40 days after myocardial infarction） or non-ischemic cardiomyopathy patients （with left ventricular ejection fraction ≤45% and age≥ 21 years） admitted to Peking Union Medical College Hospital from January 1, 2007 to December 31, 2009 were retrospectively studied. The patients were classified into two groups according to eGFR： CKD group （eGFR 〈60 ml·min^-1 .1.73 m^-2） and control group （eGFR≥60 ml·min^-1 .1.73 m^-2）. Results A total of 242 patients were screened. Of those 41 patients were excluded because of disaccording with the inclusion criteria, 201 patients were followed up （all-cause mortality） , and 14 patients （7%） were lost to follow-up. A total of 36 patients died from any cause during （20 ±9 ） months of follow up, including 21 patients （30%） in CKD group and 15 patients （13%） in control group （P = 0. 003 ）. Conclusions CKD is associated with increased mortality in CHF patients. In CHF patients combined with CKD, the treatment for CKD is as important as the treatment for CHF.