Prevalence and Progression of Chronic Kidney Disease in Adult Patients With Sickle Cell Disease
Prevalence and Progression of Chronic Kidney Disease in Adult Patients With Sickle Cell Disease
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DOI：
10.1097/01.jim.0000446836.75352.72
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发表时间：
2014-06-01
影响因子：
2.6
通讯作者：
Adams-Graves, Patricia E.
中科院分区：
文献类型：
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作者：
Gosmanova, Elvira O.;Zaidi, Sahar;Adams-Graves, Patricia E.
目的：评估18岁及以上镰状细胞病(SCD)患者5年间慢性肾脏病(CKD)的患病率和进展情况。根据估计的肾小球滤过率(EGFR)定义慢性肾脏疾病I至V期，根据2012年肾脏疾病改善全球预后建议，基于现场尿蛋白/肌酐比率定义蛋白尿分级。在EGFR大于60mL/min/1.73m(2)的患者中，如果存在A2或A3级蛋白尿，则诊断为CKD。慢性肾脏疾病进展被定义为CKD分期增加，EGFR较基线降低超过25%。结果：基线时，28.6%的患者患有CKD。经过平均5.0(SD，0.9)年的随访，17名患者发展为新的CKD，总的CKD患病率上升到41.8%。此外，8名患者经历了慢性肾脏病的进展。单因素分析显示，年龄(P=0.003)、高收缩压(BP；P=0.003)、低表皮生长因子受体(P=0.001)、高血肌酐(P=0.001)和A3蛋白尿(P=0.008)与慢性肾脏病的发生和进展有关。多因素分析显示，基线A3蛋白尿(调整后优势比5.0；95%可信区间1.1~2 4.3；P=0.048)和收缩压每升高1 mm Hg(调整后优势比1.0 4；95%可信区间1.0~1.0 7；P=0.039)可预测慢性肾脏病的发生和发展。一些基线、可改变和不可改变的因素与SCD患者CKD的发生和进展有关。针对血压控制和蛋白尿的策略可能对SCD患者有利。
Aim: We evaluated the prevalence and progression of chronic kidney disease (CKD) during the 5-year period in a cohort of patients with sickle cell disease (SCD) aged 18 years and older.Methods: We studied 98 patients with SCD. Chronic kidney disease stages I through V were defined based on estimated glomerular filtration rate (eGFR), and albuminuria grades were defined based on spot urine protein-to-creatinine ratio according to the 2012 Kidney Disease Improving Global Outcomes recommendations. In patients with eGFR of greater than 60 mL/min per 1.73 m(2), CKD was diagnosed if grade A2 or A3 albuminuria was present. Chronic kidney disease progression was defined as an increase in CKD stage with an additional eGFR reduction of more than 25% from baseline.Results: At baseline, 28.6% of patients had CKD. After a mean follow-up of 5.0 (SD, 0.9) years, 17 patients developed new CKD and the overall CKD prevalence increased to 41.8%. In addition, 8 patients experienced CKD progression. The following baseline variables were associated with the development and progression of CKD in univariate analysis: older age (P = 0.003), higher systolic blood pressure (BP; P = 0.003), lower eGFR (P = 0.001), higher serum creatinine (P = 0.001), and A3 albuminuria (P = 0.008). In multivariate analysis, baseline A3 albuminuria (adjusted odds ratio, 5.0; 95% confidence interval, 1.1-24.3; P = 0.048) and each 1-mm Hg increase in systolic BP (adjusted odds ratio, 1.04; 95% confidence interval, 1.0-1.07; P = 0.039) predicted CKD development and progression.Conclusions: Chronic kidney disease is common in patients with SCD and its prevalence increases with age. Several baseline modifiable and nonmodifiable factors were associated with the development and progression of CKD in patients with SCD. Strategies targeting BP control and proteinuria may be beneficial for individuals with SCD.