Baseline predictors of renal disease progression in the African American study of hypertension and kidney disease
Baseline predictors of renal disease progression in the African American study of hypertension and kidney disease
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DOI：
10.1681/asn.2005101101
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发表时间：
2006-10-01
影响因子：
13.6
通讯作者：
Appel, Lawrence J.
中科院分区：
文献类型：
--
作者：
Norris, Keith C.;Greene, Tom;Appel, Lawrence J.
患有慢性肾脏疾病的患者进展为终末期肾病的风险增加。这项研究的目的是检查预测不良肾脏结局风险增加的因素。对1094例黑人高血压肾病患者(GFR为20~65ml/min/1.73m2)进行COX回归分析，评估38个基线危险因素预测GFR每1.73m2下降50%或25ml/min或终末期肾病(ESRD)的临床综合结局的可能性。患者是试验参与者，他们被随机分配到两个BP目标中的一个和三个降压方案中的一个，并进行了3到6.4年的随访。在未经调整和调整的分析中，基线蛋白尿始终与不良肾脏结局的风险增加相关，即使在蛋白尿水平较低的情况下也是如此。在按GFR水平分层的分析中，蛋白尿与不良肾结局的关系也很明显，GFR本身与不良肾结局有关，但仅限于40毫升/分钟的水平。在调整了基线GFR、年龄和性别后，在调整了基线蛋白尿和不调整基线蛋白尿的情况下，与肾脏事件增加显著相关的其他因素包括血清肌酐、尿素氮和磷。在患有高血压肾硬化症的黑人患者中，蛋白尿增加、肾小球滤过率降低以及血清肌酐、尿素氮和磷水平升高与不良临床肾脏事件直接相关。这些发现确定了这一高危人群中可能受益于更积极治疗的一部分。
Patients with chronic kidney disease have an increased risk for progression to ESRD. The purpose of this study was to examine factors that predict increased risk for adverse renal outcomes. Cox regression was performed to assess the potential of 38 baseline risk factors to predict the clinical renal composite outcome of 50% or 25-ml/min per 1.73 m2 GFR decline or ESRD among 1094 black patients with hypertensive nephrosclerosis (GFR 20 to 65 ml/min per 1.73 M2). Patients were trial participants who had been randomly assigned to one of two BP goals and to one of three antihypertensive regimens and followed for a range of 3 to 6.4 yr. In unadjusted and adjusted analyses, baseline proteinuria was consistently associated with an increased risk for adverse renal outcomes, even at low levels of proteinuria. The relationship of proteinuria with adverse renal outcomes also was evident in analyses that were stratified by level of GFR, which itself was associated with adverse renal outcomes but only at levels < 40 ml/min. Other factors that were significantly associated with increased renal events after adjustment for baseline GFR, age, and gender, both with and without adjustment for baseline proteinuria, included serum creatinine, urea nitrogen, and phosphorus. In black patients with hypertensive nephrosclerosis, increased proteinuria, reduced GFR, and elevated levels of serum creatinine, urea nitrogen and phosphorus were directly associated with adverse clinical renal events. These findings identify a subset of this high-risk population that might benefit from even more aggressive treatment.