肾功能与老年人心力衰竭风险：前瞻性队列研究
eGFR与心衰结局呈U型关系，低eGFR风险升高，高eGFR关联不显著。
要点
- 白蛋白尿（UACR≥3.0 mg/mmol）与心衰住院和心衰死亡风险增加相关。
- 低eGFR（如<60 mL/min/1.73 m²）与心衰住院、心衰死亡及复合终点风险升高相关。
- 高eGFR（如>90 mL/min/1.73 m²）与心衰风险的关联不显著，可能为残余混杂。
核心结论
- 在社区老年人中，白蛋白尿与心衰住院、心衰死亡及复合终点风险升高相关，支持其用于心衰风险评估。
- 低eGFR与心衰住院、心衰死亡及复合终点风险升高相关，高eGFR的关联不确切。
主要发现
- 中位随访8.6年，354名（1.98%）参与者首次因心衰住院，147名（0.82%）死于心衰。
- 白蛋白尿（UACR≥3.0 mg/mmol，占11.3%）者心衰住院HR 1.47（95%CI 1.12-1.92），心衰死亡HR 1.55（95%CI 1.04-2.33），复合终点HR 1.33（95%CI 1.05-1.70）。
- 白蛋白尿者心衰再入院风险亦升高（HR 1.30，95%CI 1.03-1.65），但心衰死亡风险无差异。
- eGFR与心衰住院、心衰死亡及复合终点呈U型关系，低eGFR（如<60 mL/min/1.73 m²）和高eGFR（如>90 mL/min/1.73 m²）风险均升高，但高eGFR关联不显著。
- eGFR与心衰再入院无关联。
关键数值与推荐
- 白蛋白尿定义为UACR≥3.0 mg/mmol。
- eGFR低值示例<60 mL/min/1.73 m²，高值示例>90 mL/min/1.73 m²。
临床怎么用
- 对社区老年人评估心衰风险时，可考虑检测白蛋白尿和eGFR，尤其关注白蛋白尿及低eGFR者。
- 高eGFR与心衰风险的关联不确切，不宜据此常规风险分层。
局限性
- 高eGFR与心衰风险的关联不显著，可能反映残余混杂，应视为假设生成。
- 观察性设计不能确立因果关系。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: We examined whether impaired kidney function, identified through elevated levels of urine albumin to creatinine ratio (UACR) or reduced estimated glomerular filtration rate (eGFR), is associated with hospitalisation or death due to heart failure (HF) in a large community-based cohort of older adults. METHODS: We included 17 834 participants from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and follow-up ASPREE eXTension observational study with complete baseline data on albuminuria and eGFR. HRs for hospitalisation due to HF (HHF), HF death, a composite outcome of HHF and HF death, and HF re-admission were calculated using Cox models adjusting for potential confounders. RESULTS: Over a median follow-up of 8.6 years, 354 (1.98%) participants had a first hospitalisation for HF and 147 (0.82%) died due to HF. Participants with albuminuria (UACR ≥3.0 mg/mmol; 11.3%) had higher risk for HHF, HF death and the combined HF outcome compared with those with no albuminuria (HRs 1.47 (95% CI 1.12 to 1.92), 1.55 (95% CI 1.04 to 2.33) and 1.33 (95% CI, 1.05 to 1.70), respectively). In participants with albuminuria, there was also an increased risk for re-admission due to HF (HR 1.30 (95% CI 1.03 to 1.65)), although there was no difference in risk of HF death. For eGFR, a U-shaped relationship was observed with increased risk of HHF, HF death and the HF composite outcome at both low (eg, <60 mL/min/1.73 m²) and high (eg, >90 mL/min/1.73 m²) eGFR levels. However, the association at high eGFR was not statistically significant and may reflect residual confounding. No association was observed between eGFR and HF re-admission. CONCLUSIONS: In this large cohort of older adults, albuminuria was associated with increased risk of HF outcomes, supporting its role in HF risk assessment. Low eGFR was also linked to higher risk of HHF, HF death and the HF composite outcome. Associations with high eGFR were not conclusive and should be considered hypothesis-generating.
引用
- Buyadaa, Wolfe, Tonkin, et al. Kidney function and risk of heart failure in older adults: findings from a prospective cohort study. Heart. 2026. PMID: 40846472. doi:10.1136/heartjnl-2025-325700
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。