Introduction: Although small-sample size studies have shown that basal alterations of estimated glomerular filtration rate (eGFR) are related to short- and mid-term higher mortality in acute heart failure (AHF), there is scarce information on the influence of an altered eGFR on long-term mortality and readmissions. Therefore, this multicenter study sought to investigate the relationship between eGFR on admission for AHF and both long-term mortality and readmissions in a large sample of patients. Methods: We retrospectively evaluated 4,595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 1, 2008, to January 1, 2020. To investigate the effect of eGFR on admission with long-term morbimortality, we stratified the patients according to four eGFR categories: #x3c;30 mL·min⁻¹·1.73 m⁻² (G4 and G5 patients, n = 534), 30–44 mL·min⁻¹·1.73 m⁻² (G3b patients, n = 882), 45–59 mL·min⁻¹·1.73 m⁻² (G3a patients, n = 1,080), and ≥60 mL·min⁻¹·1.73 m⁻² (G1 and G2 patients, n = 2,099). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation within the first 24 h following admission. Results: At a median follow-up of 2.20 years, multivariate analyses revealed that compared to G1 and G2 patients, G4 and G5 patients exhibited a higher risk of all-cause (HR = 1.15, 95% CI: 01.02–1.30, p = 0.020) and cardiovascular (CV) (HR = 1.20, 95% CI: 1.04–1.39, p = 0.013) mortality. Similarly, multivariate analyses also showed that the lower the eGFR, the higher the risk of readmissions. In fact, compared to G1 and G2 patients, G4 and G5 patients displayed significantly increased incident rate ratios of total all-cause (28%), CV (26%), and HF-related (30%) readmissions. Conclusion: Data from this large study provide evidence that an eGFR below 30 mL·min⁻¹·1.73 m⁻² on admission could be an independent predictor for long-term mortality and readmissions in patients with AHF.
Cardiorenal Med 2022;12:179–187

中文翻译：

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估计肾小球滤过率对急性心力衰竭住院患者入院的长期预后影响

简介：尽管小样本研究表明估计肾小球滤过率 (eGFR) 的基础改变与急性心力衰竭 (AHF) 的短期和中期死亡率较高有关，但关于改变的影响的信息很少eGFR 对长期死亡率和再入院率的影响。因此，这项多中心研究旨在调查 AHF 入院时的 eGFR 与大样本患者的长期死亡率和再入院率之间的关系。方法：我们回顾性评估了 2008 年 1 月 1 日至 2020 年 1 月 1 日期间在三家三级医院因 AHF 入院后连续出院的 4,595 名患者。为了研究 eGFR 对入院长期死亡率的影响，我们根据四种情况对患者进行分层eGFR 类别：#x3c；30 mL·min ^-1 ·1.73 m ^-2（G4 和 G5 患者，n = 534），30–44 mL·min ^-1 ·1.73 m ^-2（G3b 患者，n = 882）， 45–59 mL·min ^-1 ·1.73 m ^-2（G3a 患者，n = 1,080），≥60 mL·min ^-1 ·1.73 m ^-2（G1 和 G2 患者，n= 2,099）。eGFR 是在入院后的第一个 24 小时内通过慢性肾脏病流行病学协作 (CKD-EPI) 方程式计算的。结果：在中位随访 2.20 年时，多变量分析显示，与 G1 和 G2 患者相比，G4 和 G5 患者表现出更高的全因风险（HR = 1.15，95% CI：01.02–1.30，p = 0.020) 和心血管 (CV)（HR = 1.20，95% CI：1.04–1.39，p = 0.013）死亡率。同样，多变量分析也表明，eGFR 越低，再入院的风险越高。事实上，与 G1 和 G2 患者相比，G4 和 G5 患者的全因再入院率 (28%)、CV (26%) 和 HF 相关 (30%) 再入院率显着增加。结论：来自这项大型研究的数据提供的证据表明，入院时低于 30 mL·min ^-1 ·1.73 m ^-2的 eGFR可能是 AHF 患者长期死亡率和再入院的独立预测因子。
心肾医学 2022；12:179–187