Medication Regimen And Prognosis Of Patients With End-stage Renal Disease Complicated With Heart Failure With Different Left Ventricular Ejection Fraction

OBJECTIVE: The purpose of this study was to analyze the current status of Medications therapy for heart failure in end-stage renal disease with preserved ejection fraction and heart failure with mid-range ejection fraction,to compare the risk of cardiovascular death and all-cause mortality in the two groups,and to clarify whether combined HFmr EF in end-stage renal disease To determine whether combined HFmr EF before dialysis in patients with end-stage renal disease and heart failure can be used as a prognostic indicator of cardiovascular death and all-cause death in patients with end-stage renal disease.METHODS: In this study,we collected patients with end-stage renal disease combined with heart failure treated at Yongzhou Central Hospital from January 1,2017 to August 30,2018,and improved cardiac ultrasound before dialysis,and divided them into HFp EF and HFmr EF groups according to their LVEF levels,and compared the current status of heart failure Medications use in the two groups using the x2 test,and used the Kaplan-Meier method was used to assess the survival rate of patients with endstage renal disease combined with heart failure in the two groups with different ejection fractions,and cox regression was used to screen for indicators with independent predictive value for all-cause mortality and cardiovascular death.RESULTS: A total of 197 patients with end-stage renal disease combined with heart failure,with a mean age of 60(51-68)years and 65.0% male patients,181(91.9%)in the HFp EF group and 16(8.1%)in the HFmr EF group,were finally included in the analysis of this study.In terms of receiving pharmacological treatment,43.8%,12.5%,and 6.3%of patients in the HFmr EF group received β-blockers,ACEI/ARB,and Mineralocorticoid Receptor Antagonists,respectively,and 24.3%,8.8%,and 5.0% of patients in the HFp EF group received β-blockers,ACEI/ARB,and Mineralocorticoid Receptor Antagonists,respectively.There was no significant difference in medication between the two groups,and no significant difference in all-cause mortality and cardiovascular death between the group receiving medication and the group not receiving medication.After 36 months of follow-up,there were 37 deaths in 197 patients,31 deaths and 12 cardiovascular event deaths in the HFp EF group and 6 deaths and 3 cardiovascular event deaths in the HFmr EF group,and there were significant differences in the survival curves between the two groups,which showed that patients in the HFmr EF group had lower cumulative survival rates at 6,12,24,and 36 months(87.5% vs.96.7%,81.3% vs.93.9,68.8% vs.86.7%,62.5% vs.82.9%,P=0.024),after correcting for diabetes,hypertension,dyslipidemia,coronary artery disease,hemoglobin,CRP,albumin,age,sex,smoking,dialysis pattern,and NT-pro BNP,combined HFmr EF before performing dialysis procedures was not an independent predictor of cardiovascular death and all-cause mortality in end-stage renal disease.CONCLUSION: Age,NT-pro BNP,and CRP affect the prognosis of patients with end-stage renal disease combined with heart failure.HFmr EF is not a predictor of mortality risk in patients with end-stage renal disease,and there is insufficient evidence that pharmacological treatment is beneficial in patients with end-stage renal disease combined with heart failure.