腎機能障害がHFpEFと関連
軽度および中等度の腎機能障害を有する患者は、腎機能正常者より有病率が有意に高い
ユトレヒト大学（オランダ）のRobin W.M. Vernooij氏らは、腎機能障害と左室拡張機能障害パラメータおよびHFpEFとの関連を検討した。推算糸球体濾過量（eGFR）は、人種項目除外でクレアチニンとシスタチンCに基づいて算出された。多変量調整回帰モデルを用いて、eGFRとE/e'、左室心筋重量係数、相対的壁厚、ステージCおよびDの心不全との関連を検討した。対象となったのは、平均年齢62.9歳の880人で、そのうち軽度または中等度の腎機能障害を有した患者は406人であった（それぞれ37.6％、8.5％）。
解析の結果、HFpEFの有病率は、軽度および中等度の腎機能障害者の方が、腎機能正常者より有意に高かった（それぞれ10.3％、16.0％、3.4％）。腎機能が低いほどE/e'値および相対的壁厚値が高いという関連が認められた。中等度の腎機能障害を有する人は腎機能正常者と比べて、米国心臓病学会（ACC）と米国心臓協会（AHA）の定めた心不全ステージCまたはDである確率が高かった（オッズ比2.07）。
著者らは、「中等度および軽度の腎機能障害と、拡張機能障害およびHFpEFとの間には、他のリスク因子とは独立した関連が認められた。この関連は軽度の腎機能障害ですでに認められ、中等度の腎機能障害でより強まった」と述べている。
Kidney Dysfunction Linked to Heart Failure With Preserved Ejection Fraction
Prevalence of HFpEF significantly higher in those with mild and moderate kidney dysfunction than normal kidney function
WEDNESDAY, Dec. 20, 2023 (HealthDay News) -- Mild and moderate kidney dysfunction are associated with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF), according to a study published online Nov. 27 in ESC Heart Failure.
Robin W.M. Vernooij, Ph.D., from Utrecht University in the Netherlands, and colleagues examined the association between kidney dysfunction and left ventricular diastolic dysfunction parameters and HFpEF. Estimated glomerular filtration rate (eGFR) was calculated based on creatinine and cystatin C without race. Multivariable adjusted regression models were used to test the association between eGFR and E/e', left ventricular mass index, relative wall thickness, and stage C/D heart failure. Data were included for 880 participants with a mean age of 62.9 years; 406 participants had mild or moderate kidney dysfunction (37.6 and 8.5 percent, respectively).
The researchers found that the prevalence of HFpEF was significantly higher in those with mild and moderate kidney dysfunction versus those with normal kidney function (10.3 and 16.0 percent, respectively, versus 3.4 percent). There was an association observed for higher E/e' and higher relative wall thickness values with a lower kidney function. Compared with those with normal kidney function, those with moderate kidney dysfunction had a higher likelihood of American College of Cardiology/American Heart Association stage C/D heart failure (odds ratio, 2.07).
"We found an association between moderate and mild kidney dysfunction, and diastolic dysfunction and HFpEF, independent of other risk factors," the authors write. "This association was already present for mild kidney dysfunction, and stronger for moderate kidney dysfunction."