Association of renal tubular damage with cardio-renal anemia syndrome in patients with heart failure

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• 作者：Yoichiro Otaki ; Tetsu Watanabe ; ^{tewatana@med.id.yamagata-u.ac.jp" class="auth_mail} ; Hiroki Takahashi ; Taro Narumi ; Shinpei Kadowaki ; Yuki Honda ; Takanori Arimoto ; Tetsuro Shishido ; Takuya Miyamoto ; Tsuneo Konta ; Isao Kubota
• 关键词：Renal tubular damage ; Anemia ; Heart failure ; Cardio-renal anemia syndrome
• 刊名：International Journal of Cardiology
• 出版年：1 May, 2014
• 年：2014
• 卷：173
• 期：2
• 页码：222-228
• 全文大小：701 K

文摘

Background

Cardio-renal anemia syndrome (CRAS) has begun to gather attention as a vicious circle since chronic heart failure (CHF), chronic kidney disease (CKD), and anemia are all able to be caused and exacerbated by each other. However, it remains unclear whether renal tubular damage (RTD), another type of kidney dysfunction, is associated with this vicious circle. The aim of the present study was to assess the association of RTD with CRAS in patients with CHF.

Methods and results

We included 300 consecutive patients with CHF. RTD was defined as a urinary 尾₂-microglobulin to creatinine ratio 鈮?#xA0;300 渭g/g. Patients with RTD had lower serum iron and higher levels of high sensitivity C-reactive protein than those without it. Multivariate logistic analysis showed that RTD was closely associated with anemia in patients with CHF, after adjustment for confounding factors. During a median period of 1098 days, there were 86 cardiac events, including 14 cardiac deaths and 72 re-hospitalizations for worsening heart failure. Net reclassification improvement was significantly improved by addition of RTD to the model including age, New York Heart Association functional class, brain natriuretic peptide, anemia, and CKD. All patients were divided into 3 groups: CRAS + RTD group, CRAS group, and control group. Kaplan-Meier analysis demonstrated that CRAS + RTD had the greatest risk in patients with CHF.

Conclusions

RTD was associated with normocytic anemia, accompanying iron deficiency and inflammation. RTD added prognostic information to conventional CRAS, suggesting the importance of RTD in cardio-renal anemia interaction.