Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan
Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan
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DOI：
10.1016/s0272-6386(04)01080-7
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发表时间：
2004-11-01
影响因子：
13.2
通讯作者：
Takishita, S
中科院分区：
文献类型：
--
作者：
Iseki, K;Kinjo, K;Takishita, S
背景：慢性肾脏疾病和低肌酐清除率（CrCl）相对常见，尤其是在老年人群中。然而，低CrCl的肾脏结局尚不清楚。方法：对1993年日本冲绳的冲绳一般健康维护协会进行的大规模筛查的参与者进行调查。共研究了95，255例年龄大于20岁的受试者（40，157例男性，55，098例女性），这些受试者的血清肌酐（SCr）数据可用。使用Cockcroft-Gault方法计算CrCl作为肾小球滤过率的替代标志物。在冲绳接受治疗的所有透析患者均在冲绳透析研究登记中心独立登记。使用2个计算机登记系统识别1993年筛选中后来进入透析项目的受试者。终末期肾病（ESRD）的累积发生率根据四分位数的基线CrCl水平计算。在校正年龄、性别、血压和蛋白尿后，通过考克斯分析评价CrCl对发生ESRD风险的意义。结果：CrCl值按四分位数分布：CrCl I，小于50.2 mL/min（= 1.32 mL/s; n = 23，036）。在透析登记研究中确定了181例有SCr水平数据的受试者。在有蛋白尿的患者中，每1,000例受试者中7年的ESRD累积发生率分别为CrCl I 86.8、CrCl II 13.6、CrCl III 8.3和CrCl IV 7.9，而在无蛋白尿的患者中分别为1.2、0.7、0.04和0.13。随着CrCl类别的降低，发生ESRD风险的校正风险比为4.353（95%置信区间，3.412至5.553; P < 0.0001）。结论：低CrCl（CrCl 1，
Background: Chronic kidney disease and a low creatinine clearance (CrCl) are relatively common, particularly in the aged population. However, the renal outcome of a low CrCl is not known. Methods: Participants in a 1993 mass screening conducted by the Okinawa General Health Maintenance Association in Okinawa, Japan, were investigated. A total of 95,255 subjects (40,157 men, 55,098 women) older than 20 years for whom serum creatinine (SCr) data were available were studied. CrCl was calculated as a surrogate marker of glomerular filtration rate by using the Cockcroft-Gault method. All dialysis patients who were treated in Okinawa were independently registered in the Okinawa Dialysis Study registry. Participants in the 1993 screening who later entered a dialysis program were identified by using the 2 computer registries. The cumulative incidence of end-stage renal disease (ESRD) was calculated according to baseline CrCl level in quartiles. The significance of CrCl for the risk for developing ESRD was evaluated by means of Cox analysis after adjusting for age, sex, blood pressure, and proteinuria. Results: CrCl values were distributed into quartiles: CrCl I, less than 50.2 mL/min (= 1.32 mL/s; n = 23,036). One hundred eighty-one subjects with data for SCr level were identified in the dialysis registry. Seven-year cumulative incidences of ESRD per 1,000 subjects were 86.8 in CrCl I, 13.6 in CrCl II, 8.3 in CrCl III, and 7.9 in CrCl IV in patients who had proteinuria, whereas they were 1.2, 0.7, 0.04, and 0.13 in those who did not have proteinuria, respectively. As CrCl category decreased, the adjusted hazard ratio for the risk of developing ESRD was 4.353 (95% confidence interval, 3.412 to 5.553; P < 0.0001). Conclusion: The prevalence of a low CrCl (CrCl 1,