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Prognostic Impact of Cardio-renal-anemia Syndrome in Patients at Risk for Heart Failure from the IMPACT-ABI study

Shoin, Wataru Ebisawa, Soichiro Saigusa, Tatsuya Sakai, Takahiro Oguchi, Yasutaka Okada, Ayako Motoki, Hirohiko Kuwahara, Koichiro 信州大学

2020.06.18

概要

Background : Cardio-renal-anemia syndrome (CRAS) is known as a vicious circle, since chronic heart failure (CHF), chronic kidney disease (CKD), and anemia are exacerbated by each other. However, it remains unclear whether CKD and anemia would be associated with cardiovascular events in asymptomatic patients at risk for HF.

Methods : We retrospectively enrolled patients without prior HF history who were hospitalized for cardiovascu­ lar diseases between 2005 and 2012. Patients were divided into two groups with or without RAS defined as suffering from CKD (estimated Glomerular filtration rate (eGFR) <60 mL/min/1.73 m2) and anemia (hemoglobin<13 g/dL in men and <12 g/dL in women). The primary endpoint was major adverse cardiovascular events (MACE), the composite of cardio-vascular death and HF hospitalization.

Results : A total of 1801 patients were enrolled. The mean age was 69.6±10.6 years, and 76 % were men. The mean LV ejection fraction was 66.9±12.3 %, and stage A HF was present in 73 % of the patients. Over a 4.6- year median follow-up, primary endpoint was observed in 129 patients. In Kaplan-Meier analysis, patients with RAS (n=217) showed worse prognoses than those without RAS (n=1584). In multivariable Cox proportional haz­ ards analysis, after the adjustment for age, sex, and conventional risk factors, RAS showed significant associa­ tion with the incidence of MACE (HR 1.86 ; 95 % CI 1.20-2.89, P=0.005).

Conclusions : In patients at risk for HF, RAS was significantly associated with future cardiovascular events. Investigation of the impact of early intervention for preventing CKD and anemia on those patientsʼ prognosis is warranted. Shinshu Med J 68 : 139―147, 2020

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