贫血可加速心衰患者的肾功能减退

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Anemia Linked to a Rapid Decrease in Kidney Function in Heart Failure

NEW YORK (Reuters Health) May 18 - Results of a study published in the April 15th issue of the American Journal of Cardiology indicate that anemia is a risk factor for kidney function decline in patients with heart failure, especially in those with underlying chronic kidney disease.

Dr. Mark J. Sarnak, of Tufts-New England Medical Center, Boston, Massachusetts, and colleagues performed a secondary analysis of data from the Studies of Left Ventricular Dysfunction (SOLVD) trial, a randomized trial of enalapril versus placebo in patients with decreased ejection fractions.

Following randomization, creatinine measurements were taken at 2 weeks, 6 weeks, 4 months, and every 4 months thereafter. A rapid decrease in kidney function was defined as a decrease in estimated glomerular filtration rate (GFR) of at least 6 mL/min per 1.73 m per year. Anemia was defined as a baseline hematocrit of less than 36%.

A total of 6360 subjects, mean age of 59 years, were included in the study. Overall, 31% of subjects had chronic kidney disease (CKD), defined as baseline GFR no greater than 60 mL/min per 1.73 m, and 6% had anemia.

The median follow-up time was 2 years.

In multivariate analysis, the investigators found that subjects with anemia were 30% more likely to have a rapid decrease in kidney function than those without anemia. \"This relation was modified by the level of kidney function,\" Dr. Sarnak's team reports. \"In subjects with CKD, the odds of rapid decrease in GFR were 71% greater in those with anemia, whereas in subjects without CKD, the odds of rapid decrease in GFR were only 16% greater.\"

The researchers say that, \"curiously,\" ACE inhibition did not protect against the progression of kidney impairment, possibly because of the low prevalence of proteinuric kidney disease in the cohort. \"In addition, the use of ACE inhibitors is associated with anemia, and it is possible that the exacerbation of anemia may also contribute to the absence of a protective effect against kidney disease progression with ACE inhibitor use.\"

Am J Cardiol 2007;99:1137-1142.

http://www.medscape.com/viewarticle/556781