Does inflammation fuel the fire in CKD?
Does inflammation fuel the fire in CKD?
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炎症会加剧 CKD 的火势吗？
DOI：
10.1053/j.ajkd.2009.01.001
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Sarnak,MarkJ
中科院分区：
文献类型：
--
作者：
Rifkin,DenaE;Sarnak,MarkJ
自1961年Frawling研究的里程碑式出版物确定吸烟是一种可改变的心脏风险因素以来，预防心脏病学领域蓬勃发展，风险因素分析科学已应用于其他慢性疾病。最令人感兴趣的是识别不仅是疾病的预测因素，而且是可改变和因果关系的风险因素：例如心血管疾病（CVD），性别是预测因素，但不可改变;同型半胱氨酸水平是预测因素，可改变，但不一定是因果关系;并且高血压是可预测的、可改变的和因果的，因为治疗可靠地降低了疾病的风险。对于慢性肾病（CKD），风险因素可分为肾损伤开始的风险和已建立的肾损伤进展的风险。与CVD不同，在CVD中，可识别的“事件”划分了从风险和亚临床疾病到明显疾病的转变，CKD通常是无症状的，并且损伤的标志物，如蛋白尿很少。因此，对于大多数患者，CKD首先被诊断为估计的肾小球滤过率（GFR）低于60 ml/min/1.73 m2。这种诊断是连续谱上的一个点，因此超过CKD阈值更可能是进展的标志，而不是开始。尽管肾功能丧失具有持续性，但在终末期肾病（ESRD）之前，GFR低于60 ml/min/1.73 m2的估计值，与无数并发症相关，包括CVD、3，4肌无力、5认知异常、6住院、3身体损伤7和高成本。8因此，寻找早期治疗和预防CKD的新靶点将是一个重大进展。
Since the landmark 1961 publication from the Framingham Study identifying smoking as a modifiable cardiac risk factor, 1 the field of preventive cardiology has burgeoned, and the science of risk factor analysis 2 has been applied to other chronic diseases. Of most interest is the identification of risk factors that are not only predictive of disease but are also both modifiable and causal: for the example of cardiovascular disease (CVD), gender is predictive, but non-modifiable; homocysteine levels are predictive, modifiable, but not necessarily causal; and hypertension is predictive, modifiable, and causal, in that treatment reliably reduces the risk of disease.For chronic kidney disease (CKD), risk factors can be divided into risk of initiation of kidney damage and risk for progression of established kidney damage. Unlike CVD, where identifiable ‘events’ demarcate the transition from risk and subclinical disease to overt disease, CKD is typically asymptomatic, and markers of damage, such as albuminuria, are few. Thus for most patients, CKD is first diagnosed as an estimated glomerular filtration rate (GFR) less than 60ml/min/1.73 m2. This diagnosis is a point on a continuous spectrum, so that passing the CKD threshold is more likely a sign of progression rather than initiation. Despite the continuous nature of kidney function loss, passing below an estimated GFR of 60 ml/min/1.73 m2–well prior to end-stage renal disease (ESRD)--has been associated with a myriad of complications, including CVD, 3, 4 muscle weakness, 5 cognitive abnormalities, 6 hospitalizations, 3 physical impairment7 and high cost. 8 Thus, finding new targets for early treatment and prevention of CKD would be a major advance.