Supplementary Material for: A New Era in the Management of Cardiorenal Syndrome: The Importance of Cardiorenal Units.

Introduction: Approximately 70% of patients with heart failure (HF) also have kidney disease. Mortality is increased both by cardiorenal syndrome (CRS) and by the exacerbation of other comorbidities. The purpose of this study is to evaluate the clinical performance of patients with CRS who are followed up by the Cardiorenal Unit (CRU).

Methods: We conducted a retrospective observational study of patients referred to the CRU from April 1, 2022, to April 30, 2023. Demographics, laboratory and ultrasonographic tests, and outcomes were evaluated.

Results: Fifty-four patients were seen in the CRU. A total of 45 (83%) and 16 (30%) patients completed follow-up in the CRU at 6 and 12 months, respectively. The mean age was 70 years±1.6, and 65% were men. Almost 50% of patients had ischemic heart disease-related HF. The mean cardiac ejection fraction (EF) was 40%±1.6, and 61% of patients had HF with reduced EF (HFrEF). NYHA functional classes II and III were the most frequent (60% and 35%, respectively). At six months after follow-up, treatment was optimized with sacubitril-valsartan in 33% vs. 49% (p=0.02) and SGLT2 inhibitors in 48% vs. 72% (p=0.008), without significant deterioration in renal function (creatinine: p=0.61; eGFR: p=0.19). There was also a reduction of more than 50% in the number of hospital admissions (p=0.002). A total of 22% required peritoneal dialysis, and 20% required hemodialysis. Ten (19%) patients died, five of them due to cardiovascular (CV) events.

Conclusions: The CRU is vital for the management of complex patients, as it ensures the implementation of medications that reduce CV mortality and decrease the number of hospital admissions in HF.

引言：约70%的心力衰竭（heart failure, HF）患者同时合并肾脏疾病。心肾综合征（cardiorenal syndrome, CRS）以及其他共病的加重均会升高患者的死亡率。本研究旨在评估接受心肾病房（Cardiorenal Unit, CRU）随访的心肾综合征患者的临床诊疗表现与结局。
方法：本研究为回顾性观察性研究，纳入2022年4月1日至2023年4月30日间转诊至心肾病房的患者。研究对患者的人口统计学特征、实验室及超声检查结果与临床结局进行了评估。
结果：心肾病房共接诊54例患者。其中分别有45例（83%）与16例（30%）患者完成了6个月与12个月的随访。患者平均年龄为70岁±1.6岁，男性占比65%。近50%的患者为缺血性心脏病相关心力衰竭。平均心脏射血分数（ejection fraction, EF）为40%±1.6%，61%的患者为射血分数降低的心力衰竭（HF with reduced EF, HFrEF）。纽约心脏协会（NYHA）功能分级Ⅱ级与Ⅲ级最为常见，占比分别为60%与35%。随访6个月时，沙库巴曲缬沙坦的优化用药比例从基线的33%升至49%（p=0.02），钠-葡萄糖协同转运蛋白2抑制剂（SGLT2 inhibitors）的优化用药比例从48%升至72%（p=0.008）；同期患者肾功能未出现显著恶化（肌酐：p=0.61；估算肾小球滤过率（estimated glomerular filtration rate, eGFR）：p=0.19）。患者的住院次数较基线减少超过50%（p=0.002）。共有22%的患者需要接受腹膜透析，20%的患者需要接受血液透析。10例（19%）患者死亡，其中5例死于心血管（cardiovascular, CV）事件。
结论：心肾病房对于复杂患者的管理至关重要，其可确保临床采用能够降低心力衰竭患者心血管死亡率并减少住院次数的治疗方案。