Kidney stones and kidney function loss: a cohort study.
Kidney stones and kidney function loss: a cohort study.
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DOI：
10.1136/bmj.e5287
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发表时间：
2012-08-29
期刊：
影响因子：
--
通讯作者：
Alberta Kidney Disease Network
中科院分区：
文献类型：
--
作者：
Alexander RT;Hemmelgarn BR;Wiebe N;Bello A;Morgan C;Samuel S;Klarenbach SW;Curhan GC;Tonelli M;Alberta Kidney Disease Network
目的探讨肾结石的存在是否增加终末期肾病（ESRD）或其他不良肾脏结局的风险。设计一项基于索赔和设施利用数据的注册队列研究。中位随访11年。以加拿大的阿尔伯塔为背景，1997年至2009年。参与者3 089 194例基线时无ESRD或有肾盂肾炎病史的成人患者。其中，1 954 836人进行了门诊血清肌酐测量，并被纳入慢性肾脏疾病和血清肌酐水平加倍的分析。随访期间出现一个或多个肾结石。主要结局指标：ESRD事件、3b-5期慢性肾脏疾病的发展（估计肾小球滤过率<45 mL/min/1.73 m2）和血清肌酐浓度较基线持续加倍。结果23706例（0.8%）患者至少有一个肾结石，5333例（0.2%）发展为ESRD，68525例（4%）发展为3b-5期慢性肾脏病，6581例（0.3%）发生持续性血清肌酐加倍。总体而言，随访期间发生一次或多次结石事件与ESRD风险增加相关（校正风险比2.16（95% CI 1.79 - 2.62）），新发3b-5期慢性肾脏疾病（风险比1.74（1.61 - 1.88））和血清肌酐加倍（风险比1.94（1.56 - 2.43）），所有这些都与随访期间无肾结石的患者进行了比较。与至少一次结石发作相关的不良结局的超额风险似乎在女性中高于男性，并且在年龄<50岁的人群中高于年龄≥ 50岁的人群。然而，在性别和年龄层中，至少有一次结石发作的患者发生所有三种不良结局的风险均显著高于无结石患者。与结石相关的不良肾脏结局发生率的绝对增加很小：在有一次或多次结石发作的人群中，未调整的ESRD发生率为2.48/百万人天，而在无结石的人群中为0.52/百万人天。结论：即使是随访期间的单一肾结石发作，也与包括ESRD在内的不良肾脏结局的可能性显著增加相关。然而，从绝对值来看，增长幅度很小。
Objective To investigate whether the presence of kidney stones increase the risk of end stage renal disease (ESRD) or other adverse renal outcomes. Design A registry cohort study using validated algorithms based on claims and facility utilisation data. Median follow-up of 11 years. Setting Alberta, Canada, between 1997 and 2009. Participants 3 089 194 adult patients without ESRD at baseline or a history of pyelonephritis. Of these, 1 954 836 had outpatient serum creatinine measurements and were included in analyses of chronic kidney disease and doubling of serum creatinine level. Exposure One or more kidney stones during follow-up. Main outcome measures Incident ESRD, development of stage 3b–5 chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73 m2), and sustained doubling of serum creatinine concentration from baseline. Results 23 706 (0.8%) patients had at least one kidney stone, 5333 (0.2%) developed ESRD, 68 525 (4%) developed stage 3b–5 chronic kidney disease, and 6581 (0.3%) experienced sustained doubling of serum creatinine. Overall, one or more stone episodes during follow-up was associated with increased risk of ESRD (adjusted hazard ratio 2.16 (95% CI 1.79 to 2.62)), new stage 3b–5 chronic kidney disease (hazard ratio 1.74 (1.61 to 1.88)), and doubling of serum creatinine (hazard ratio 1.94 (1.56 to 2.43)), all compared with those without kidney stones during follow-up. The excess risk of adverse outcomes associated with at least one episode of stones seemed greater in women than in men, and in people aged <50 years than in those aged ≥50. However, the risks of all three adverse outcomes in those with at least one episode of stones were significantly higher than in those without stones in both sexes and age strata. The absolute increase in the rate of adverse renal outcomes associated with stones was small: the unadjusted rate of ESRD was 2.48 per million person days in people with one or more episodes of stones versus 0.52 per million person days in people without stones. Conclusion Even a single kidney stone episode during follow-up was associated with a significant increase in the likelihood of adverse renal outcomes including ESRD. However, the increases were small in absolute terms.
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艾伯塔省肾脏疾病网络的概述。
影响因子：
2.3
作者：
Hemmelgarn BR;Clement F;Manns BJ;Klarenbach S;James MT;Ravani P;Pannu N;Ahmed SB;MacRae J;Scott-Douglas N;Jindal K;Quinn R;Culleton BF;Wiebe N;Krause R;Thorlacius L;Tonelli M
通讯作者：
Tonelli M
影响因子：
6.6
作者：
Trinchieri, A;Ostini, F;Zanetti, G
通讯作者：
Zanetti, G
影响因子：
2.9
作者：
Hippisley-Cox, Julia;Coupland, Carol
通讯作者：
Coupland, Carol
影响因子：
--
作者：
Stankus, Nicole;Hammes, Mary;Worcester, Elaine
通讯作者：
Worcester, Elaine
影响因子：
4.2
作者：
Lieske, JC;Monico, CG;Milliner, DS
通讯作者：
Milliner, DS