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在美国退伍军人中,KDIGO定义的CKD的结果具有HFpEF,HFmrEF和HFrEF
Samir Patel1, Venkatesh K Raman2, Charles Faselis3
1Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
JACC. Heart failure
|February 7, 2025
概括
慢性病 (CKD) 显著增加心力衰竭 (HF) 患者的死亡率和住院风险,涉及所有喷射分数类型. 这些风险随着功能下降而升级,这凸显了在HF护理中管理CKD的重要性.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
背景情况:
- 根据KDIGO指南定义的慢性病 (CKD) 与心力衰竭 (HF) 患者的不良结果有关.
- 不完全理解CKD对HF不同左心室喷射小部分 (LVEF) 类别的结果的影响.
研究的目的:
- 确定KDIGO定义的CKD的患病率和结果,这些患者患有心力衰竭与保存喷射分数 (HFpEF),心力衰竭轻微减少喷射分数 (HFmrEF) 和心力衰竭减少喷射分数 (HFrEF).
主要方法:
- 从1991年到2017年,使用电子健康记录分析了1,446,053名HF退伍军人的大量队列.
- 根据估计的膜过率 (eGFR) <60 mL/min/1.73 m2或白尿,与正常功能 (NKF) 作为比较剂,确定了CKD.
- 考克斯回归模型估计了与HFpEF,HFmrEF和HFrEF组的CKD类别相关的5年全因死亡率和HF住院风险.
主要成果:
- 与NKF相比,CKD与死亡风险 (16-26%) 和HF住院风险 (31-33%) 与所有HF亚型的NKF相比显著更高.
- 这些风险随着eGFR水平的降低而逐渐增加,除了eGFR<15mL/min/1.73m2外,可能是由于透析开始.
- 在所有HF组中,白膜尿也独立地增加了死亡率 (10-16%) 和HF住院 (24-30%) 的风险.
结论:
- 根据KDIGO定义的CKD是普遍存在的,并且与HFpEF,HFmrEF和HFrEF患者的结果差得多.
- 这些发现强调了在心力衰竭患者中考虑和管理慢性脏病的关键需要,无论他们的喷射分数如何.
- 该研究提供了有价值的见解,了解CKD在各种高频人口中真正的流行率和预后影响.
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