Dividing CKD stage 3 into G3a and G3b could better predict the prognosis of IgA nephropathy.
Dividing CKD stage 3 into G3a and G3b could better predict the prognosis of IgA nephropathy.
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将CKD 3期分为G3a和G3b可以更好地预测IgA肾病的预后
DOI：
10.1371/journal.pone.0175828
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Zhang JJ;Yu GZ;Zheng ZH;Liu YF;Du YY;Quan SX;Liu YJ;Lv JC;Zhang H
在2013年肾脏疾病改善全球预后指南中，慢性肾脏疾病(CKD)阶段3被分为G3a阶段和G3b阶段。以45mL/min/1.73m2作为G3a/G3b分期的阈值是否合适，将CKD分期为G3a/G3b是否对评估IgA肾病(IgAN)患者的预后有价值尚不清楚。入选郑州大学第一附属医院和北京大学第一医院的390例慢性肾脏病第三期IgA肾病患者，并成功随访。用COX比例风险模型分析不同肾小球滤过率(EGFR)、肾小球滤过率(EGFR)15ml/min/1.73m2、肾脏替代治疗或死亡患者到达复合终点的风险比和影响复合终点的危险因素。采用Kaplan-Meier法计算患者的累积肾存活率。当EGFR低于45ml/min/每1.73m2时，到达复合终点的CKD 3期患者的危险比急剧增加。G3a组和G3b组患者的肾脏损害和预后差异有统计学意义。G3b期是影响预后的主要危险因素。以45ml/min/1.73m2为临界值评估CKD 3期IgAN患者的预后是合适的。将CKD 3期患者分为G3a和G3b有助于了解病情和预测疾病进展的风险。
Chronic kidney disease (CKD) stage 3 was divided into stage G3a and stage G3b in the 2013 Kidney Disease Improving Global Outcomes guidelines. Whether it is appropriate to regard 45 mL/min/per 1.73 m2 as the threshold value of G3a/G3b staging and whether dividing CKD stage 3 into G3a/G3b plays a useful role in assessing the prognosis of patients with IgA nephropathy (IgAN) remain unknown. Three hundred and ninety patients from the First Affiliated Hospital of Zhengzhou University and Peking University First Hospital diagnosed with IgAN in CKD stage 3 were enrolled and successfully followed up. Cox proportional hazards model was used to analyze hazard ratios of reaching the composite endpoints (doubling of serum creatinine, end-stage renal disease: estimated glomerular filtration rate (eGFR) <15 ml/min/per 1.73 m2 or renal replacement therapy, or death) for patients with different eGFR and risk factors affecting composite endpoints. The Kaplan–Meier method was used to calculate the cumulative renal survival rate of patients. When eGFR was lower than 45 ml/min/per 1.73 m2, the hazard ratio increased sharply for patients in CKD stage 3 who reached the composite endpoints. Renal injury and prognosis were significantly different between patients in the G3a and G3b groups. Stage G3b was a major risk factor affecting prognosis. A threshold value of 45 ml/min/per 1.73 m2 appears appropriate to assess the prognosis of IgAN patients with CKD stage 3. Dividing IgAN patients with CKD stage 3 into G3a and G3b is very useful to help understand disease conditions and for predicting the risk for disease progression.