Estimated GFR Trajectories in Pediatric and Adult Nephrotic Syndrome: Results From the Nephrotic Syndrome Study Network (NEPTUNE).
Estimated GFR Trajectories in Pediatric and Adult Nephrotic Syndrome: Results From the Nephrotic Syndrome Study Network (NEPTUNE).
复制标题
儿童和成人肾病综合征的估计 GFR 轨迹：来自肾病综合征研究网络 (NEPTUNE) 的结果。
DOI：
10.1016/j.xkme.2020.03.006
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发表时间：
2020
期刊：
影响因子：
3.9
通讯作者：
Mariani,LauraH
中科院分区：
文献类型：
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作者：
Smith,AbigailR;Zee,Jarcy;Ji,Nan;Troost,JonathanP;Gillespie,BrendaW;Nair,Viji;Liu,Qian;Gibson,KeishaL;Kretzler,Matthias;Mariani,LauraH
原理与目的终末期肾脏疾病的代偿结局通常呈线性变化，这可能不能反映真实估计的肾小球滤过率(EGFR)轨迹。这项研究的目的是描述肾病综合征的非线性表皮生长因子受体的轨迹。研究设计观察性队列研究。设置和参与者肾病综合征研究网络(NEPOTINE)是一项多中心研究，研究对象是在临床表现为肾脏活检或疾病初始表现的成人和儿童患者(仅限儿童)。预测者在研究登记和随访时间时，患者的人口统计学、临床和病理变量。结果GFR使用慢性肾脏疾病流行病学协作(患者年龄为18岁)或改良的慢性肾脏疾病儿童研究-≥(患者年龄：18岁)公式计算。采用多元线性回归分析预测因素与非线性概率之间的关系。结果纳入453例≥患者，平均随访时间为3.6年。PNL中位数为0.052；PNL10%、GT；50%分别为56%和16%。在成人和儿童患者中，较高的基线EGFR与较高的PNL相关，而较长的随访时间与较低的PNL相关。在成人中，较高的尿蛋白/肌酐比和类固醇使用也与较高的PNL相关。在成人中，肾小管萎缩和足突消失的比例较高，分别与较低和较高的PNL相关。限制：相对较短的随访时间，无法评估急性肾损伤事件，以及患者间EGFR测量频率的变化。结论尽管随访时间的增加导致更多的线性轨迹，但非线性的EGFR轨迹在该队列中很常见。未来对肾病综合征的研究应该考虑不依赖线性假设的新结果。
Rationale & ObjectiveSurrogate outcomes for end-stage kidney disease often assume linear changes, which may not reflect true estimated glomerular filtration rate (eGFR) trajectories. This study’s objective was to characterize nonlinear eGFR trajectories in nephrotic syndrome.Study DesignObservational cohort study.Setting & ParticipantsNephrotic Syndrome Study Network (NEPTUNE) is a multicenter study of adult and pediatric patients with proteinuria enrolled at clinically indicated kidney biopsy or initial presentation of disease (pediatric only).PredictorsPatient demographic, clinical, and pathology variables at study enrollment and follow-up time.OutcomeeGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (patients ≥ 18 years old) or modified Chronic Kidney Disease in Children Study–Schwartz (patients < 18 years) formulas. The probability of nonlinearity (PNL) was calculated for individual eGFR trajectories.Analytical ApproachAssociations between predictors and PNL were assessed using multivariable linear regression.Results453 patients with ≥3 eGFR measurements and 1 or more year of follow-up were included (median follow-up, 3.6 years). Median PNL was 0.052; 56% and 16% had PNL < 10% and >50%, respectively. In both adults and pediatric patients, higher baseline eGFR was associated with higher PNL, whereas longer follow-up time was associated with lower PNL. Higher urine protein-creatinine ratio and steroid use were also associated with higher PNL in adults. Higher percentages of tubular atrophy and foot-process effacement were associated with lower and higher PNLs, respectively, in adults.LimitationsRelatively short follow-up time, inability to assess acute kidney injury events, and variable eGFR measurement frequency across patients.ConclusionsAlthough increasing follow-up time resulted in more linear trajectories, nonlinear eGFR trajectories were common in this cohort. Future studies in nephrotic syndrome should consider novel outcomes that do not rely on linearity assumptions.