肾功能恶化与心力衰竭用药相关

关键信息

心力衰竭（HF）用药可能会导致肾功能恶化，不过其对临床结局的影响尚未得到确证。该研究对TIME-CHF进行了析因分析，旨在确定6个月内肾功能的下降情况。研究所针对的HF用药包括袢利尿剂、β阻滞剂、RAS阻滞剂以及螺內酯。结果发现，肾功能恶化的患者所应用的袢利尿剂（P=0.0002）剂量较大，螺內酯应用也较多（P=0.02），但是β阻滞剂（P=0.69）并未造成显著差异。应用β阻滞剂（P <0 .001）和RAS阻滞剂（P = 0.006）的患者的预后较好。

大剂量的袢利尿剂可能会造成有害影响，在肾功能严重恶化的患者中尤为如此。螺內酯和β阻滞剂对于肾功能恶化的患者可能具有保护性作用。

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While medication for heart failure (HF) may lead to deteriorating renal function, the clinical impact is not clear. Researchers used a post hoc analysis of TIME-CHF to identify worsening renal function over 6 months. Loop diuretics, beta blockers, RAS blockers, and spironolactone were considered. Those with worsening renal function received higher doses of loop diuretics (P = .0002) and more spironolactone (P = .02), but the use of beta blockers (P = 0.69) did not differ. Prognosis was better with beta blockers (P < .001) and RAS blockade (P = .006).

High doses of loop diuretics might have detrimental effects, especially in combination with significant worsening renal function. Spironolactone and beta blockers may be protective in patients with worsening renal function.

European Journal of Heart Failure

Impact of Worsening Renal Function Related to Medication in Heart Failure

Eur. J. Heart Fail 2014 Dec 30;[EPub Ahead of Print], H-P Brunner-La Rocca, C Knackstedt, L Eurlings, V Rolny, F Krause, ME Pfisterer, D Tobler, P Rickenbacher, MT Maeder

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