Pablo Díez-Villanueva , César Jiménez-Méndez , Ángel Pérez-Rivera , Eduardo Barge Caballero , Javier López , Carolina Ortiz , Clara Bonanad , Josebe Goirigolzarri , Alberto Esteban Fernández , Marta Cobo , Nuria Montes , Albert Ariza-Solé , Manuel Martínez-Sellés , Fernando Alfonso
{"title":"Different impact of chronic kidney disease in older patients with heart failure according to frailty","authors":"Pablo Díez-Villanueva , César Jiménez-Méndez , Ángel Pérez-Rivera , Eduardo Barge Caballero , Javier López , Carolina Ortiz , Clara Bonanad , Josebe Goirigolzarri , Alberto Esteban Fernández , Marta Cobo , Nuria Montes , Albert Ariza-Solé , Manuel Martínez-Sellés , Fernando Alfonso","doi":"10.1016/j.ejim.2024.12.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF</div></div><div><h3>Methods</h3><div>Our data come from the FRAGIC study (“<em>impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca</em>\"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model.</div></div><div><h3>Results</h3><div>We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m<sup>2</sup>. Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m<sup>2</sup>, 182 patients, 36 %), moderately impaired (eGFR 30–59 ml/min/1.72m<sup>2</sup>, 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m<sup>2</sup>, 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, <em>p</em> = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality.</div></div><div><h3>Conclusions</h3><div>Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"132 ","pages":"Pages 90-96"},"PeriodicalIF":5.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0953620524004977","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF
Methods
Our data come from the FRAGIC study (“impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model.
Results
We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m2. Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m2, 182 patients, 36 %), moderately impaired (eGFR 30–59 ml/min/1.72m2, 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m2, 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality.
Conclusions
Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.
背景：慢性肾脏疾病（CKD）和虚弱常存在于老年心力衰竭（HF）患者中。方法：我们的数据来自FRAGIC研究（“FRAGilidad y otros的影响síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio不充分Cardíaca”），这是一项多中心前瞻性登记研究，在西班牙的16个心脏病中心进行，其中包括≥75岁的HF门诊患者。根据CKD-EPI公式评估肾功能。进行全面的老年评估，并根据视觉活动能力量表（VMS≥2则虚弱）确定虚弱。生存率采用Cox回归模型分析。结果：纳入499例患者，平均年龄81.4±4.3岁，女性占38%。平均估计肾小球滤过率（eGFR）为52.1±17.5 ml/min/1.72 m2。患者分为肾功能正常（eGFR≥60 ml/min/1.72m2, 182例，36%）、中度肾功能受损（eGFR 30-59 ml/min/1.72m2, 261例，52.7%）、重度肾功能受损（eGFR2, 56例，11.3%）。严重CKD患者年龄较大，多为女性，临床表现较差，合并症负担和虚弱程度较高。中位随访371天后，58例患者（11.6%）死亡。单因素分析中，肾功能较差（按肾功能亚组分别为8.8%、11%和21%，p = 0.036）和虚弱的患者死亡率较高。然而，根据VMS，只有虚弱，而不是严重的肾功能不全，与1年死亡率独立相关。结论：大多数≥75岁的HF患者存在肾功能不全。CKD是老年慢性心衰患者预后较差的一个标志，但在存在虚弱的情况下，它并不能独立地与一年死亡率相关。
期刊介绍：
The European Journal of Internal Medicine serves as the official journal of the European Federation of Internal Medicine and is the primary scientific reference for European academic and non-academic internists. It is dedicated to advancing science and practice in internal medicine across Europe. The journal publishes original articles, editorials, reviews, internal medicine flashcards, and other relevant information in the field. Both translational medicine and clinical studies are emphasized. EJIM aspires to be a leading platform for excellent clinical studies, with a focus on enhancing the quality of healthcare in European hospitals.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
