Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
复制标题
DOI：
10.1016/j.kint.2018.02.006
复制
发表时间：
2018-06
影响因子：
19.6
通讯作者：
Conference Participants
中科院分区：
文献类型：
--
作者：
Eckardt KU;Bansal N;Coresh J;Evans M;Grams ME;Herzog CA;James MT;Heerspink HJL;Pollock CA;Stevens PE;Tamura MK;Tonelli MA;Wheeler DC;Winkelmayer WC;Cheung M;Hemmelgarn BR;Conference Participants
肾小球滤过率（GFR）严重降低的患者（即慢性肾病[CKD] G4+）发生肾衰竭、心血管疾病（CVD）事件（包括心力衰竭）和死亡的风险增加。然而，对结果的可变性和最佳治疗策略知之甚少，包括开始肾脏替代治疗（KRT）。肾脏疾病：改善全球结果（KDIGO）于2016年12月与一个国际专家组组织了一次争议会议，以解决这一知识差距。与CKD预后联盟（CKD- pc）合作，进行了一项全球队列研究荟萃分析（n = 264,515名CKD G4+患者），以更好地了解CKD G4+患者临床结果的时间和不同结果的危险因素。结果证实了传统心血管疾病危险因素对GFR严重降低个体的预后价值，尽管肾脏和心血管疾病结果的风险估计有所不同。一个2年和4年的肾脏衰竭需要KRT的概率和时间模型也被开发出来。这些发现对患者管理的意义在已发表的证据的背景下讨论了4个关键主题：CKD G4+的管理，心力衰竭的诊断和治疗挑战，共同决策，以及CKD G4+患者临床试验的优化。参与者得出结论，晚期CKD患者的可变预后需要个性化的、基于风险的管理，考虑竞争风险和患者偏好。
Patients with severely decreased glomerular filtration rate (GFR) (i.e., chronic kidney disease [CKD] G4+) are at increased risk for kidney failure, cardiovascular disease (CVD) events (including heart failure), and death. However, little is known about the variability of outcomes and optimal therapeutic strategies, including initiation of kidney replacement therapy (KRT). Kidney Disease: Improving Global Outcomes (KDIGO) organized a Controversies Conference with an international expert group in December 2016 to address this gap in knowledge. In collaboration with the CKD Prognosis Consortium (CKD-PC) a global meta-analysis of cohort studies (n = 264,515 individuals with CKD G4+) was conducted to better understand the timing of clinical outcomes in patients with CKD G4+ and risk factors for different outcomes. The results confirmed the prognostic value of traditional CVD risk factors in individuals with severely decreased GFR, although the risk estimates vary for kidney and CVD outcomes. A 2- and 4-year model of the probability and timing of kidney failure requiring KRT was also developed. The implications of these findings for patient management were discussed in the context of published evidence under 4 key themes: management of CKD G4+, diagnostic and therapeutic challenges of heart failure, shared decision-making, and optimization of clinical trials in CKD G4+ patients. Participants concluded that variable prognosis of patients with advanced CKD mandates individualized, risk-based management, factoring in competing risks and patient preferences.
登录
查看更多内容
DOI：
10.1093/ndt/gfv346
发表时间：
2016-02
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
作者：
Bhandari S;Ives N;Brettell EA;Valente M;Cockwell P;Topham PS;Cleland JG;Khwaja A;El Nahas M
通讯作者：
El Nahas M
影响因子：
24
作者：
Bansal N;Katz R;Robinson-Cohen C;Odden MC;Dalrymple L;Shlipak MG;Sarnak MJ;Siscovick DS;Zelnick L;Psaty BM;Kestenbaum B;Correa A;Afkarian M;Young B;de Boer IH
通讯作者：
de Boer IH
DOI：
10.2215/cjn.03860609
发表时间：
2010-01-01
影响因子：
9.8
作者：
Cohen, Lewis M.;Ruthazer, Robin;Germain, Michael J.
通讯作者：
Germain, Michael J.
DOI：
10.2215/cjn.00510109
发表时间：
2009-10-01
影响因子：
9.8
作者：
Carson, Rachel C.;Juszczak, Maciej;Burns, Aine
通讯作者：
Burns, Aine
影响因子：
158.5
作者：
Cooper, Bruce A.;Branley, Pauline;Pollock, Carol A.
通讯作者：
Pollock, Carol A.