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Abstract：
Background/Objectives: Cardiorenal syndrome (CRS) is a disorder of the heart and kidneys, with one type of organ dysfunction affecting the other. The pathophysiology is complex, and its actual description has been questioned. We used clustering analysis to identify clinically relevant phenogroups among patients with CRS. Methods: Data for patients admitted from 1 January 2012 to 31 December 2012 were collected from the French national medico-administrative database. Patients with a diagnosis of heart failure and chronic kidney disease and at least 5 years of follow-up were included. Results: In total, 13,665 patients were included and four clusters were identified. Cluster 1 could be described as the vascular-diabetes cluster. It comprised 1930 patients (14.1%), among which 60% had diabetes, 94% had coronary artery disease (CAD), and 80% had peripheral artery disease (PAD). Cluster 2 could be described as the vascular cluster. It comprised 2487 patients (18.2%), among which 33% had diabetes, 85% had CAD, and 78% had PAD. Cluster 3 could be described as the metabolic cluster. It comprised 2163 patients (15.8%), among which 87% had diabetes, 67% dyslipidemia, and 62% obesity. Cluster 4 comprised 7085 patients (51.8%) and could be described as the low-vascular cluster. The vascular cluster was the only one associated with a higher risk of cardiovascular death (HR: 1.48 [1.32-1.66]). The metabolic cluster was associated with a higher risk of kidney replacement therapy (HR: 1.33 [1.17-1.51]). Conclusions: Our study supports a new classification of CRS based on the vascular aspect of pathophysiology differentiating microvascular or macrovascular lesions. These results could have an impact on patients\' medical treatment.
摘要：
背景/目的：心肾综合征（CRS）是一种心脏和肾脏疾病，一种器官功能障碍会影响另一种。病理生理学很复杂,它的实际描述受到质疑。我们使用聚类分析来识别CRS患者中临床相关的表型群。方法：2012年1月1日至2012年12月31日收治的患者数据来自法国国家医学管理数据库。包括诊断为心力衰竭和慢性肾脏疾病以及至少5年随访的患者。结果：总的来说，纳入13,665名患者，并确定了4个集群。集群1可以描述为血管糖尿病集群。它包括1930名患者（14.1％），其中60%患有糖尿病，94%患有冠状动脉疾病(CAD)，80%患有外周动脉疾病(PAD)。簇2可以被描述为血管簇。它包括2487名患者（18.2%），其中33%患有糖尿病，85%有CAD,78%患有PAD。簇3可以被描述为代谢簇。包括2163名患者（15.8%），其中87%患有糖尿病，67%血脂异常，和62%的肥胖。第4组包括7085名患者(51.8%)，可以描述为低血管簇。血管簇是唯一与心血管死亡风险较高相关的簇(HR:1.48[1.32-1.66])。代谢簇与肾脏替代治疗的高风险相关（HR：1.33[1.17-1.51]）。结论：我们的研究支持基于病理生理学的血管方面区分微血管或大血管病变的CRS新分类。这些结果可能对患者的药物治疗产生影响。
