老年冠心病无症状心肌缺血和心绞痛并发慢性左心室收缩功能不全患者肾小球滤过率估测值与血红蛋白浓度的相关性

目的探讨老年冠心病无症状性心肌缺血和心绞痛并发慢性左心室收缩功能不全(CLVSD)患者肾小球滤过率估测值(eGFR)与血红蛋白(Hb)浓度的相关性。方法收集≥60岁冠状动脉造影证实冠心病无症状性心肌缺血和心绞痛患者235例,其中,超声心动图检测左心室射血分数(LVEF)50%110例归为CLVSD组〔LVEF(37.72±5.68)%〕;LVEF≥50%余125例归为非CLVSD组〔LVEF(60.25±5.56)%〕。上述两组据eGFR分别再分为eGFR60 ml.min-1.1.73 m-2组与eGFR≥60 ml.min-1.1.73 m-2组,回顾性分析此两组间Hb浓度差异。结果与非CLVSD组比较,CLVSD组Hb浓度显著增高〔(114.57±23.34)和(120.92±18.92)g/L,P0.05〕。LVEF与Hb浓度显著负相关(r=-0.18,P0.05)。CLVSD组中,与≥60 ml.min-1.1.73 m-2组比较〔(84.36±16.80)ml.min-1.1.73 m-2〕,eGFR60 ml.min-1.1.73 m-2组〔(46.28±11.90)ml.min-1.1.73 m-2〕,Hb浓度显著降低〔(123.12±18.98)和(112.79±16.10)g/L,P0.05〕,eGFR与Hb浓度显著正相关(r=0.24,P0.05)。在非CLVSD组中,与eGFR≥60 ml.min-1.1.73 m-2组比较〔(90.39±20.75)ml.min-1.1.73 m-2〕,eGFR60 ml.min-1.1.73 m-2组〔(44.11±12.44)ml.min-1.1.73 m-2〕Hb浓度亦显著降低〔(116.47±20.63)和(108.10±30.08)g/L,P0.05〕,eGFR与Hb浓度亦显著正相关(r=0.18,P0.05)。结论老年冠心病无症状性心肌缺血和心绞痛并发CLVSD患者Hb浓度显著增高,Hb浓度与LVEF显著负相关,而与eGFR显著正相关。     

肾小球滤过率水平对老年患者死亡情况的影响

目的分析基线估算肾小球滤过率(eGFR)对老年患者的死亡情况的影响。方法回顾性分析60岁及以上患者的临床资料。利用CKD-EPI公式计算基线eGFR,将其分为A组(eGFR<60 ml.min-1.1.73 m-2)及B组(eGFR≥60 ml.min-1.1.73 m-2),分析两组患者死亡情况。并将A组患者根据基线eGFR分为Aa组(eGFR≥45 ml.min-1.1.73 m2)和Ab组(eGFR<45 ml.min-1.1.73 m-2),通过χ2检验分析两组患者的全因死亡有无差异。结果初始年龄60岁及以上患者共582例,符合入选标准的568例,A组患者145例,B组423例,平均研究时间为(8.22±1.77)(3～14)年,死亡患者共72例(全因死亡率12.68%),A组死亡35例(全因死亡率24.14%),B组死亡37例(全因死亡率8.75%),两组间全因死亡率差异具有统计学意义(P=0.001)。χ2检验分析显示A与B组心血管疾病(CVD)死亡率、严重感染死亡率、死前行CRRT比率有统计学差异;Aa组共121例,死亡24例(死亡率19.84%),Ab组24例,死亡11例(死亡率45.83%),两组间有统计学差异(P=0.007)。结论eGFR<60 ml.min-1.1.73 m-2的老年患者的全因死亡率、CVD死亡率、严重感染死亡率及死前行连续性肾脏替代治疗(CRRT)比率均高于eGFR≥60 ml.min-1.1.73 m-2的患者;老年患者的全因死亡率随着基线eGFR的降低明显增加。     

肾小球滤过率估测值评判老年高血压及2型糖尿病并发终末期肾病患者血红蛋白浓度的变化

目的探讨用肾小球滤过率估测值(eGFR)评判的老年高血压及2型糖尿病并发终末期肾病(ESRD)患者血红蛋白(Hb)浓度改变。方法收集高血压及2型糖尿病并发慢性肾病且≥60岁患者230例,将eGFR15ml.min-1.1.73m-2(7.80±3.14ml.min-1.1.73m-2)者归为ESRD组,eGFR≥15ml.min-1.1.73m-2(29.76±12.90ml.min-1.1.73m-2)者归为非ESRD组,回顾性比较两组间Hb浓度。结果较非ESRD组〔Hb(100.8±23.0)g/L〕,ESRD组Hb浓度〔(74.4±22.5)g/L〕显著降低(P0.05),且在ESRD与非ESRD组中eGFR均与Hb浓度显著正相关(P0.05)。结论eGFR评判的老年高血压及2型糖尿病并发ESRD患者Hb浓度显著降低,且eGFR与Hb浓度具有显著正相关性。     

入院肾小球滤过率对ST段抬高心肌梗死患者急诊介入治疗术后心肌灌注及预后的影响

目的 评价入院估算的肾小球滤过率(eGFR)对接受急诊PCI治疗的ST段抬高型心肌梗死(STEMI)患者冠状动脉血流和预后的影响.方法 回顾性收集因STEMI而在12 h内接受急诊PCI治疗的患者495例.根据患者入院时eGFR分为两组:eGFR≥60 ml·min-1·1.73 m-2组和eGFR ＜60 ml·min-1·1.73 m-2组.比较两组患者的临床资料、介入手术资料和1年随访资料.结果 eGFR＜ 60 ml·min-1·1.73 m-2组96例,eGFR≥60 ml·min-1·1.73 m-2组399例.与eGFR≥60 ml·min-1 ·1.73 m-2组相比,eGFR ＜60 ml·min-1·1.73 m-2组患者入院时年龄更大,男性患者更多,多支病变患者更多,高血压患者更多,既往心肌梗死病史患者增加,入院及出院eGFR更低,Killip's分级更高.eGFR ＜60 ml·min-1 ·1.73 m-2组校正TIMI计帧数比eGFR≥60 ml·min-1 ·1.73 m-2组更高,并且TIMI心肌灌注分级(TMP)0 ～1级患者更多(5.0％比14.6％).入院eGFR＜ 60 ml· min-1·1.73 m-2是接受急诊PCI的STEMI患者心肌灌注不良(校正相对危险度OR=3.95,95％CI:1.23 ～ 6.89)和1年死亡率(校正OR=1.48,95％ CI:1.21 ～ 2.97)的独立预测因子.结论 入院eGFR下降与急诊PCI治疗的STEMI患者心肌灌注不良和预后不良相关.     

SHARP研究的潜在临床意义及存在的不足

<正>他汀类药物治疗降低低密度脂蛋白胆固醇(LDL-C),可降低无肾病患者的心肌梗死(MI)、缺血性卒中危险,并减少其冠状动脉血运重建的需要。对于eGFR高于60 ml.min-1.1.73 m-2的的慢性肾病患者来说,心血管病的病因常常由于动脉粥样硬化所致,他汀类药物治疗带来的益处独立于肾功能。但当eGFR低于30 ml.min-1.1.73 m-2时,肾病患者合并其他的心血管病理生理变化,例如血管硬化、钙化,心脏     

脂蛋白(a)与老年慢性心肾综合征的相关性研究

目的探讨脂蛋白(a)[lipoprotein (a), Lp(a)]水平和老年慢性心肾综合征(cardiorenal syndrome, CRS)的相关性。方法选取2017年12月至2019年10月于河北省人民医院心血管内科住院, 年龄≥65岁的老年慢性心力衰竭(chronic heart failure, CHF)患者。根据估算的肾小球滤过率(estimate glomerular filtration rate, eGFR)水平, 分为CRS组(eGFR<60 ml·min-1·1.73 m-2)和单纯CHF组(eGFR≥60 ml·min-1·1.73 m-2)。收集患者空腹血液指标、基础疾病情况和心脏超声指标, 评估2组患者各临床指标和心肾功能指标[左心室射血分数(left ventricular ejection fraction, LVEF)和eGFR]的相关性, 采用多因素logistic回归分析老年CRS的相关因素以及不同基础疾病亚组LP(a)水平和CRS的相关性。结果最终纳入172例研究对象, 男性85例(49.4%), 年龄79(71, 84)岁。其中CRS组...     

贫血增加慢性心力衰竭患者死亡率

目的调查贫血在慢性心力衰竭(CHF)住院患者中发生率,以及与CHF患者死亡率的关系。方法收集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,根据是否贫血[血红蛋白<120 g/L(男性)或110 g/L(女性)]分为两组,贫血组和对照组,并进行电话随访。结果共242例患者入选,对197例进行随访,14例(7.1%)失访,经过平均(20±9)个月(2～41个月)随访,共36例(20%)发生全因死亡,包括贫血组13例(34%)和对照组23例(16%)(χ2=6.415,P=0.011)。结论贫血在CHF住院患者中常见,贫血增加CHF死亡率,因此在积极抗心力衰竭治疗同时应高度重视贫血的纠正,以更好地改善CHF患者预后。     

不同状态肾功能与冠心病发病率及冠状动脉病变严重程度的分析

目的探讨不同程度肾功能降低患者的冠心病发病率及其冠状动脉病变的严重程度。方法收集9608例行诊断性冠状动脉造影疑诊冠心病的患者进行回顾性分析,依据适合中国人的改良MDRD方程估算的肾小球滤过率(eGFR)水平将患者分为肾功能正常(>90ml·min-1.1.73m-2)、轻度降低(60～89ml·min-1.1.73m-2)、中度降低(30～59ml·min-1.1.73m-2)和重度降低(<29ml·min-1.1.73m-2)4组,探讨不同程度肾功能损害患者的冠心病发病率及其冠状动脉狭窄的严重程度。结果 9608例患者中存在肾功能降低(eGFR<90ml·min-1.1.73m-2)者4939例,占51.4%。肾功能降低组患者冠心病发病率显著高于肾功能正常组(55.7%比44.3%,P<0.001),且冠状动脉狭窄程度更为严重,表现为患者病变支数更多(1.38±1.13比1.06±1.08,P<0.001)、Gensini积分更高(29.36±35.53比21.32±30.30,P<0.001)。肾功能正常组与轻度、中度、重度降低组患者冠心病的发病率分别为59.7%、69.4%、79.1%、92.3%,冠心病发病率随肾功能降低的程度而明显增高(P<0.001)。线性回归分析显示:Gensini积分与慢性肾病(Chronic kidney disease,CKD)分期(β=0.061,OR值3.219,95%CI:2.075～4.364,P<0.001)呈独立正相关。Logistic回归分析证实:CKD与冠心病诊断存在显著关联(OR值1.330,95%CI:1.177～1.503,P<0.001)。结论肾功能降低患者的冠心病发病率明显升高,且其冠状动脉狭窄程度更为严重;患者肾功能降低越显著,则冠心病发病率越高;肾功能降低与冠状动脉狭窄程度呈独立正相关;CKD与冠心病发生存在显著关联。     

老年慢性肾脏病与非慢性肾脏病患者肾小球滤过率随增龄变化的差异

目的观察基线年龄为70岁、患慢性肾脏病(CKD)及未患CKD老年患者的肾小球滤过率(eGFR)在10年内的逐年变化情况。方法回顾2000年1月1日至2010年1月1日住院治疗的262例70岁患者的临床资料,筛选出具有完整10年血肌酐、年龄和性别的病例。利用CKD-EPI公式计算eGFR,根据结果将患者分为CKD组[eGFR60 ml/(min·1.73 m~2)]和非CKD组[eGFR≥60 ml/(min·1.73 m~2)],通过SPSS16.0统计软件分析两组10年内eGFR的逐年变化速度并比较两组间的差异。利用Logistic回归分析基础疾病,包括高血压、高脂血症、高尿酸血症、肾结石、肾囊肿、糖尿病、心血管病及脑血管病对两组eGFR逐年变化速度差异有无影响。结果 262例患者中具有完整10年资料者212例,其中CKD组76例(35.8%),非CKD组136例(64.2%)。SPSS16.0箱图和误差图显示两组eGFR的变化速度在10年内都呈现下降趋势,且各组逐年的平均变化速度相对恒定,其中CKD组为(-1.67±0.95)ml/(min·1.73 m~2),非CKD组为(-0.39±1.05)ml/(min·1.73 m~2),两组差异有统计学意义(P0.05)。多变量Logistic回归分析显示高血压、糖尿病、心血管病、高尿酸血症及脑血管病在两组间差异有统计学意义(P0.05)。结论老年CKD和非CKD患者的eGFR逐年变化速度存在统计学差异;高血压、糖尿病、心血管病、高尿酸血症及脑血管病可能是导致老年人eGFR逐年变化速度差异的危险因素。     

两种公式估算的肾小球滤过率对慢性心力衰竭患者远期预后预测价值比较研究

目的 比较两种公式计算的肾小球滤过率(eGFR)水平对慢性心力衰竭(CHF)患者全因死亡事件的预测价值。方法 纳入2006年1月至2014年8月于中国中医科学院广安门医院心内科住院的CHF患者546例,使用简化肾脏病膳食改良试验(MDRD)公式及基于血肌酐水平的慢性肾脏病流行病合作研究(CKDEPI)公式分别计算e GFR,并进行分组(A组e GFR≥90 ml/min·1.73 m²;B组90 ml/min·1.73 m²>e GFR≥60ml/min·1.73 m²;C组e GFR<60 ml/min·1.73 m²)。采用电话问卷等方式进行随访,主要研究终点为全因死亡。应用Bland-Altman图比较两种方程及一致性相关系数估算e GFR的相关性和一致性;采用受试者工作曲线(ROC)及Kaplan-Meier生存曲线评价e GFR对CHF全因死亡的预测能力;使用Cox回归风险模型估计e GFR与远期预后的相关性。结果 两种公式评估eGFR值的相关性和一致性较差(P<0.00...     

代谢综合征及其组分与慢性肾脏病的关系

目的 探讨心内科住院患者代谢综合征(MS)及其组分与慢性肾脏病(CKD)之间的关系.方法 对525例心内科住院患者进行横断面研究,测定身高、体重、腰围、血脂等生化指标,未确诊糖尿病的患者进行葡萄糖耐量试验.根据肌酐(Cr)计算肾小球滤过率(eGFR)诊断CKD,采用国际糖尿病联盟(IDF)全球共识定义诊断MS.结果 (1)MS患者肌酐水平显著高于非MS患者,eGFR水平显著低于非MS患者[Cr(93.81±31.06)μmol/L比(108.65±36.05)μmol/L,P<0.001;eGFR(61.14±17.40)ml·min-1·1.73 m-2比(73.64±17.03)ml·min-1·1.73 m-2,P<0.001].(2)eGFR水平随MS组分数量的增多而逐渐下降,有5个MS组分时eGFR水平最低.(3)调整年龄、性别和其他可能影响肾脏功能的因素后,与非MS患者相比,MS患者CKD的危险比为4.34(95%02.766～6.805);与有0个或1个MS组分的患者相比,有3、4、5个MS组分的患者CKD的危险比(95%CI)分别为3.12(1.41～6.89)、8.21(3.78～17.82)和14.72(6.14～35.30);MS组分中的血压增高、高血糖、腹型肥胖、高甘油三酯血症与CKD的危险比(95%CI)分别为1..5(1.04～2.92)、1.98(1.26～3.11)、2.42(1.41～4.16)和2.65(1.68～4.19).结论 MS及其组分与CKD之间有显著的相关性,这种相关性随MS组分的增多而增加.除MS组分中的血压增高和高血糖外,腹型肥胖和高甘油三酯血症也增加CKD的风险,故CKD的发生可能是MS中的多重危险因素共同作用的结果.     

Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function: Insights from the EMPEROR-Preserved trial

Aim

In the EMPEROR-Preserved trial, empagliflozin improved clinical outcomes of patients with heart failure (HF) with preserved ejection fraction. In this pre-specified analysis, we aim to study the effect of empagliflozin on cardiovascular and kidney outcomes across the spectrum of kidney function.

Methods and results

Patients were categorized by the presence or absence of chronic kidney disease (CKD) at baseline (CKD defined by an estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m² or urine albumin to creatinine ratio >300 mg/g). The primary and key secondary outcomes were (i) a composite of cardiovascular death or first HF hospitalization (primary outcome); (ii) total number of HF hospitalization, (iii) eGFR slope; and a pre-specified exploratory composite kidney outcome including a sustained ≥40% decline in eGFR, chronic dialysis or renal transplant. The median follow-up was 26.2 months. A total of 5988 patients were randomized to empagliflozin or placebo, of whom 3198 (53.5%) had CKD. Irrespective of CKD status, empagliflozin reduced the primary outcome (with CKD: hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.69–0.94; without CKD: HR 0.75, 95% CI 0.60–0.95; interaction p = 0.67) and total (first and recurrent) hospitalizations for HF (with CKD: HR 0.68, 95% CI 0.54–0.86; without CKD: HR 0.89, 95% CI 0.66–1.21; interaction p = 0.17). Empagliflozin slowed the slope of eGFR decline by 1.43 (1.01–1.85) ml/min/1.73 m²/year in patients with CKD and 1.31 (0.88–1.74) ml/min/1.73 m²/year in patients without CKD (interaction p = 0.70). Empagliflozin did not reduce the pre-specified kidney outcome in patients with or without CKD (with CKD: HR 0.97, 95% CI 0.71–1.34; without CKD: HR 0.92, 95% CI 0.58–1.48; interaction p = 0.86) but slowed progression to macroalbuminuria and reduced the risk of acute kidney injury. The effect of empagliflozin on the primary composite outcome and the key secondary outcomes was consistent across five baseline eGFR categories (all interaction p >0.05). Empagliflozin was well tolerated independent of CKD status.

Conclusions

In EMPEROR-Preserved, empagliflozin had a beneficial effect on the key efficacy outcomes in patients with and without CKD. Overall, the benefit and safety of empagliflozin was consistent across a wide range of kidney function spectrum, down to a baseline eGFR of 20 ml/min/1.73 m².     

经导管主动脉瓣置换术对主动脉瓣狭窄患者肾功能的影响

目的探讨经导管主动脉瓣置换术(TAVR)对主动脉瓣狭窄患者术后肾功能的影响。方法本研究为单中心回顾性研究。连续入选2014年10月至2019年10月在复旦大学附属中山医院行TAVR治疗的主动脉瓣狭窄患者。依据术前1 d肾小球滤过率(eGFR)将纳入患者分为4组:>90 ml·min^-1·1.73m^-2组、>60~90 ml·min^-1·1.73m^-2组、>30~60 ml·min^-1·1.73m^-2组和≤30 ml·min^-1·1.73m^-2组。术后72 h再次检测eGFR,按照术后肾功能变化将患者分为急性肾功能恢复(AKR)组、急性肾脏损伤(AKI)组和肾功能无变化组。其中AKR定义为TAVR术后72 h的eGFR值增加>基线值的25%,AKI定义为TAVR术后72 h的eGFR值降低>基线值的25%。比较各组的相关临床资料,并采用多因素logistic回归分析TAVR术后肾功能变化的影响因素。结果本研究共纳入217例因主动脉瓣狭窄行TAVR治疗的患者,年龄(76.7±7.4)岁,其中女性86例,胸外科医师学会评分为(9.5±5.8)分。>90 ml·min^-1·1.73m^-2组(n=19)、>60~90 ml·min^-1·1.73m^-2组(n=116)、>30~60 ml·min^-1·1.73m^-2组(n=70)和≤30 ml·min^-1·1.73m^-2组(n=12)术后达AKR者所占比例分别为0、30.2%(35/116)、58.6%(41/70)和75.0%(9/12);共3例(1.4%)患者发生AKI,其中>30~60 ml·min^-1·1.73m^-2组2例,>60~90 ml·min^-1·1.73m^-2组1例。eGFR<60 ml·min^-1·1.73m^-2患者中AKI发生率为2.4%(2/82)。纳入的217例患者中,AKR组85例(39.2%)、AKI组3例(1.4%)、肾功能无变化组129例(59.4%)。3组的体重指数(BMI)、术前左心室舒张末期内径(LVEDD)和术前eGFR分布差异有统计学意义(P均<0.05)。多因素logistic回归分析显示,BMI(OR=5.54,95%CI 1.04~29.58,P=0.045)、术前LVEDD(OR=1.22,95%CI 1.09~1.38,P=0.001)及术前eGFR(OR=2.23,95%CI 2.04~2.55,P=0.004)是术后非AKR的危险因素。结论TAVR术后绝大多数患者表现为肾功能不变或者改善,TAVR术后肾功能的变化与BMI及术前LVDD、eGFR相关。     

急性心肌梗死患者肾功能状态及对预后的影响

目的探评价急性ST段抬高型心肌梗死(STEMI)患者入院即刻肾功能状态及对院内预后的影响。方法多中心、前瞻性队列研究。入选自2005年12月至2007年1月,在发病后24小时内至北京市19家医院就诊的STEMI患者718例。入院即刻测定血清肌酐,根据改良的简化MDRD公式计算估计的肾小球滤过率(eGFR)。分为肾功能正常组(eGFR≥90ml/(min·1.73m2)、轻度肾功能不全组(60ml/(min·1.73m2≤eGFR90ml/(min·1.73m2)和中度肾功能不全组(eGFR60ml/(min·1.73m2),比较三组的临床特点和院内死亡和心血管事件发生情况,采用多元Logistic回归分析影响STEMI患者院内死亡和主要心血管事件的危险因素。结果 718例患者中共有280例(39.0%)已经存在不同程度的肾功能不全(eGFR90ml/min),其中61例(8.5%)为中度以上肾功能不全(eGFR60ml/min)。与肾功能正常组相比,轻度肾功能不全组和中度肾功能不全组患者年龄偏大(57±12)岁vs(66±13)岁vs(72±13)岁,P0.01),女性比例多(16.9%vs39.2%vs48.3%,P0.01),既往有高血压病(47.7%vs59.8%vs70.5%,P0.01),心力衰竭(0%vs2.7%vs6.6%,P0.01),脑卒中或一过性脑缺血(TIA)病史(8.9%vs10.6%vs19.3%,P0.05),入院时心功能Killip≥II级(34.7%vs37.0%vs65.5%,P0.01)较多。院内病死率(1.4%vs5.9%vs22.9%,P0.01)和心血管事件(18.0%vs27.4%vs63.9%,P0.01)显著增高。多因素Logistic回归分析显示入院即刻肾功能不全是STEMI患者发生院内死亡和心血管事件的独立危险因素(OR值分别为3.870;95%CI:1.767-8.474,P0.01和1.712;95%CI:1.217-2.408,P0.01)。结论 STEMI患者中肾功能不全发生率较高,院内死亡及心血管事件的发生率随肾功能恶化而增加,肾功能不全是院内死亡和心血管事件的独立危险因素。     

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

Renal dysfunction is a significant risk factor in the prognosis of patients with cardiovascular diseases. We sought to determine the relationship between estimated glomerular filtration rate (eGFR) values and in-hospital mortality in Japanese acute myocardial infarction (AMI) patients. A total of 2266 consecutive AMI patients admitted to 22 hospitals in Hokkaido were registered. The eGFR values were determined using the following equation: eGFR=194 × (serum creatinine)(-1.094) × (age)(-0.287) ( × 0.739 if female). Patients were classified into four groups according to their eGFR values: ≥60 (n=1304), 30-59 (n=810), 15-29 (n=87) and <15 ml min(-1) per 1.73 m(2) (n=65). A total of 110 patients (4.9%) died during hospitalization. The in-hospital mortality rate was significantly higher in patients with reduced eGFR values at 2.3, 5.4, 24.1 and 23.1% for eGFR values of ≥60, 30-59, 15-29, and <15 ml min(-1) per 1.73 m(2), respectively. The odds ratios for in-hospital all cause death were 8.26 (95% confidence interval (CI): 2.22-30.77) for eGFR<15 ml min(-1) per 1.73 m(2) and 3.42 (95% CI: 1.01-11.61) for eGFR 15-29 ml min(-1) per 1.73 m(2) compared with eGFR ≥60?ml?min(-1) per 1.73 m(2). Similarly, the odds ratios for in-hospital cardiac death were 8.43 (95% CI: 1.82-39.05) for eGFR<15 ml min(-1) per 1.73 m(2) and 5.47 (95% CI: 1.51-19.80) for eGFR 15-29 ml min(-1) per 1.73 m(2). In conclusion, the eGFR of <30 ml min(-1) per 1.73 m(2) was a significant and independent risk for in-hospital mortality in abroad cohort of Japanese patients with AMI.     

Association of chronic kidney disease with atrial fibrillation among adults in the United States: REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

BACKGROUND: Atrial fibrillation (AF) is common among patients with end-stage renal disease, but few data are available on its prevalence among adults with chronic kidney disease (CKD) of lesser severity. methods and results: We evaluated the association of CKD with ECG-detected AF among 26 917 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of African-American and white US adults ≥45 years of age. Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease study equation and albuminuria was defined as a urinary albumin to creatinine ratio ≥30 mg/g. Participants were categorized by renal function: no CKD (eGFR ≥60 mL/min/1.73 m(2) without albuminuria, n=21 081), stage 1 to 2 CKD (eGFR ≥60 mL/min/1.73 m(2) with albuminuria n=2938), stage 3 CKD (eGFR 30 to 59 mL/min/1.73 m(2), n=2683) and stage 4 to 5 CKD (eGFR <30 mL/min/1.73 m(2), n=215). The prevalence of AF among participants without CKD, and with stage 1 to 2, stage 3, and stage 4 to 5 CKD was 1.0%, 2.8%, 2.7% and 4.2%, respectively. Compared with participants without CKD, the age-, race-, and sex-adjusted odds ratios for prevalent AF were 2.67 (95% confidence interval, 2.04 to 3.48), 1.68 (95% confidence interval, 1.26 to 2.24) and 3.52 (95% confidence interval, 1.73 to 7.15) among those with stage 1 to 2, stage 3, and stage 4 to 5 CKD. The association between CKD and prevalent AF remained statistically significant after further multivariable adjustment and was consistent across numerous subgroups. CONCLUSIONS: Regardless of severity, CKD is associated with an increased prevalence of AF among US adults.     

高血压及糖尿病人肾小球滤过率对血栓弹力图测定的凝血功能影响

目的：利用改良的血栓弹力图技术（TEG）评估老年高血压病、糖尿病患者抗血小板治疗后凝血功能变化,探讨肾小球滤过率（eGFR）对TEG各指标的影响.方法：选择TEG、常规凝血功能检查资料完整的住院患者87例,根据eGFR分为eGFR正常组（eGFR≥90ml· min 1·1.73m-2）52例,以及eGFR低下组（eGFR＜ 90ml·min-1·1,73m-2） 35例,比较两组间服用抗血小板药物（阿司匹林和/或氯吡格雷）治疗后常规凝血功能和TEG指标的差异,分析eGFR与TEG指标间的相关性.结果：抗血小板治疗后,与eGFR正常组比较,eGFR低下组TEG; K时间[K值,（1.59±0.53） min比（1.35±0.48） min]显著减少（P=0.037）,α角度[Angle值,（66.05±7,63）＆#176;比（69.49±7.58）°、MA30min血块减少速度（Ly30）：（0.99±1.88）％比（2.80±4.60）％]显著增加;血浆纤维蛋白原水平[（2.96±0.65） mg/L比（3.60±1.08） mg/L]显著升高（P＜0.05～＜0.01）;Pearson相关性分析显示,Angle值（r=-0.308,P=0.008）、Ly30值（r=-0.258,P=0.03）均与eGFR呈负相关.结论：抗血小板治疗后高血压、糖尿病慢性肾功能损害患者血凝度仍高于肾功能正常患者;这些患者应定期检查肾功能和血栓弹力图,以评估抗血小板的效果.     

Hepatitis C virus viremia increases the incidence of chronic kidney disease in HIV-infected patients

BACKGROUND:: Several studies have reported on an association between hepatitis C virus (HCV) antibody status and the development of chronic kidney disease (CKD), but the role of HCV viremia and genotype are not well defined. METHODS:: Patients with at least three serum creatinine measurements after 1 January 2004 and known HCV antibody status were included. Baseline was defined as the first eligible estimated glomerular filtration rate (eGFR) (Cockcroft-Gault equation), and CKD was either a confirmed (>3 months apart) eGFR of 60?ml/min per 1.73?m or less for patients with a baseline eGFR more than 60?ml/min per 1.73?m or a confirmed 25% decline in eGFR for patients with a baseline eGFR of 60?ml/min per 1.73?m or less. Incidence rates of CKD were compared between HCV groups (anti-HCV-negative, anti-HCV-positive with or without viremia) using Poisson regression. RESULTS:: Of 8235 patients with known anti-HCV status, 2052 (24.9%) were anti-HCV-positive of whom 983 (47.9%) were HCV-RNA-positive, 193 (9.4%) HCV-RNA-negative and 876 (42.7%) had unknown HCV-RNA. At baseline, the median eGFR was 97.6 (interquartile range 83.8-113.0) ml/min per 1.73?m. During 36123 person-years of follow-up (PYFU), 495 patients progressed to CKD (6.0%) with an incidence rate of 14.5 per 1000 PYFU (95% confidence interval 12.5-14.9). In a multivariate Poisson model, patients who were anti-HCV-positive with HCV viremia had a higher incidence rate of CKD, whereas patients with cleared HCV infection had a similar incidence rate of CKD compared with anti-HCV-negative patients. There was no association between CKD and HCV genotype. CONCLUSION:: Compared with HIV-monoinfected patients, HIV-positive patients with chronic rather than cleared HCV infection were at increased risk of developing CKD, suggesting a contribution from active HCV infection toward the pathogenesis of CKD.