Risk factors for ESRD in individuals with preserved estimated GFR with and without albuminuria: results from the Kidney Early Evaluation Program (KEEP).
Risk factors for ESRD in individuals with preserved estimated GFR with and without albuminuria: results from the Kidney Early Evaluation Program (KEEP).
复制标题
DOI：
10.1053/j.ajkd.2012.12.016
复制
发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
KEEP Investigators
中科院分区：
文献类型：
--
作者：
Chang TI;Li S;Chen SC;Peralta CA;Shlipak MG;Fried LF;Whaley-Connell AT;McCullough PA;Kurella Tamura M;KEEP Investigators
考虑到终末期肾病（ESRD）的费用增加和预后不良，我们试图在估计肾小球滤过率（eGFR）保持不变、伴或不伴蛋白尿的ESRD高危人群中确定ESRD的风险因素。这项队列研究纳入了国家肾脏基金会肾脏早期评估项目（KEEP）中基线时eGFR ≥60 mL/min/1.73 m2的受试者，并根据是否存在白蛋白尿进行分层。使用慢性肾脏病流行病学协作方程来计算eGFR。通过半定量试纸检测尿液中的蛋白尿。结局是发生经治疗的慢性肾衰竭，定义为开始维持透析治疗或肾移植，通过与美国肾脏数据系统的联系确定。我们使用精细灰色法的考克斯模型来评估治疗慢性肾衰竭的风险因素，同时考虑死亡的竞争风险。在中位随访4.8年期间，13，923名白蛋白尿参与者中有126名（16/10，000患者-年）和109，135名无白蛋白尿参与者中有56名（1.1/10，000患者-年）发生了经治疗的慢性肾衰竭。糖尿病是伴有和不伴有白蛋白尿的受试者发生经治疗慢性肾衰竭的强风险因素（校正HR分别为9.3 [95% CI，5.7-15.3]和7.8 [95% CI，4.1-14.8]）。黑人、较低的eGFR和较高的收缩压也与发生经治疗的慢性肾衰竭的调整后风险较高相关。在一个不同的高风险队列中，我们发现糖尿病、较高的收缩压、较低的eGFR和黑人是发生治疗后慢性肾衰竭的危险因素，而与蛋白尿状态无关，尽管无蛋白尿的参与者发生肾衰竭的绝对风险非常低。我们的研究结果支持在高危人群中进行肾脏疾病检测，这些人群通常患有其他未被识别的肾脏疾病。
Given the increasing costs and poor outcomes of end-stage renal disease (ESRD), we sought to identify risk factors for ESRD in people with preserved estimated glomerular filtration rate (eGFR), with or without albuminuria, who were at high risk of ESRD. This cohort study included participants in the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP) with eGFR ≥60 mL/min/1.73 m2 at baseline stratified by the presence or absence of albuminuria. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate eGFR. Urine was tested for albuminuria by semiquantitative dipstick. The outcome was the development of treated chronic kidney failure, defined as initiation of maintenance dialysis therapy or kidney transplantation, determined by linkage to the US Renal Data System. We used a Cox model with the Fine-Gray method to assess risk factors for treated chronic kidney failure while accounting for the competing risk of death. During a median follow-up of 4.8 years, 126 of 13,923 participants with albuminuria (16/10,000 patient-years) and 56 of 109,135 participants without albuminuria (1.1/10,000 patient-years) developed treated chronic kidney failure. Diabetes was a strong risk factor for developing treated chronic kidney failure in participants with and without albuminuria (adjusted HRs of 9.3 [95% CI, 5.7–15.3] and 7.8 [95% CI, 4.1–14.8], respectively). Black race, lower eGFR, and higher systolic blood pressure also were associated with higher adjusted risks of developing treated chronic kidney failure. In a diverse high-risk cohort of KEEP participants with preserved eGFR, we showed that diabetes, higher systolic blood pressure, lower eGFR, and black race were risk factors for developing treated chronic kidney failure irrespective of albuminuria status, although the absolute risk of kidney failure in participants without albuminuria was very low. Our findings support testing for kidney disease in high-risk populations, which often have otherwise unrecognized kidney disease.
登录
查看更多内容
DOI：
10.1056/nejmoa0910975
发表时间：
2010-09-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Appel LJ;Wright JT Jr;Greene T;Agodoa LY;Astor BC;Bakris GL;Cleveland WH;Charleston J;Contreras G;Faulkner ML;Gabbai FB;Gassman JJ;Hebert LA;Jamerson KA;Kopple JD;Kusek JW;Lash JP;Lea JP;Lewis JB;Lipkowitz MS;Massry SG;Miller ER;Norris K;Phillips RA;Pogue VA;Randall OS;Rostand SG;Smogorzewski MJ;Toto RD;Wang X;AASK Collaborative Research Group
通讯作者：
AASK Collaborative Research Group
影响因子：
6.1
作者：
Van Pottelbergh, Gijs;Bartholomeeusen, Stephaan;Degryse, Jan
通讯作者：
Degryse, Jan
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
39.2
作者：
Jafar, TH;Stark, PC;Levey, AS
通讯作者：
Levey, AS
影响因子：
13.2
作者：
Munkhaugen, John;Lydersen, Stian;Hallan, Stein
通讯作者：
Hallan, Stein