Long-term outcomes in nondiabetic chronic kidney disease
Long-term outcomes in nondiabetic chronic kidney disease
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DOI：
10.1038/ki.2008.67
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发表时间：
2008-06-01
影响因子：
19.6
通讯作者：
Greene, T.
中科院分区：
文献类型：
--
作者：
Menon, V.;Wang, X.;Greene, T.
肾脏疾病饮食改良（MDRD）研究检查了严格控制血压和饮食蛋白质限制对肾脏疾病进展的影响。在此，我们回顾性评价了MDRD研究随机和非随机队列中2-4期慢性肾脏病（CKD）非糖尿病受试者的结局。从美国肾脏数据系统和国家死亡指数获得截至2000年12月的肾衰竭和生存状态。计算肾衰竭、死亡以及死亡和肾衰竭复合结局的事件发生率。在1666名患者中，肾衰竭的发生率是死亡率的四倍。在基于基线肾小球滤过率、蛋白尿、肾脏疾病病因、性别和人种的亚组中，肾衰竭是比死亡更可能的事件。只有在65岁以上的老年人中，死亡率才接近肾衰竭。与其他CKD人群相比，我们对相对年轻的非糖尿病受试者的研究发现，大多数参与者进展为肾衰竭，死亡的竞争风险较低。对于此类患者，主要重点应是延缓肾脏疾病的进展。
The Modification of Diet in Renal Disease (MDRD) Study examined the effects of strict blood pressure control and dietary protein restriction on the progression of kidney disease. Here, we retrospectively evaluated outcomes of nondiabetic participants with stages 2-4 chronic kidney disease (CKD) from randomized and nonrandomized cohorts of the MDRD Study. Kidney failure and survival status through December of 2000, were obtained from the US Renal Data System and the National Death Index. Event rates were calculated for kidney failure, death, and a composite outcome of death and kidney failure. In the 1666 patients, rates for kidney failure were four times higher than that for death. Kidney failure was a more likely event than death in subgroups based on baseline glomerular filtration rate, proteinuria, kidney disease etiology, gender, and race. It was only among those older than 65 that the rate for death approximated that for kidney failure. In contrast to other populations with CKD, our study of relatively young subjects with nondiabetic disease has found that the majority of the participants advanced to kidney failure with a low competing risk of death. In such patients, the primary emphasis should be on delaying progression of kidney disease.