GFR Decline and Mortality Risk among Patients with Chronic Kidney Disease
GFR Decline and Mortality Risk among Patients with Chronic Kidney Disease
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DOI：
10.2215/cjn.00470111
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发表时间：
2011-08-01
影响因子：
9.8
通讯作者：
Yahya, Taher
中科院分区：
文献类型：
--
作者：
Perkins, Robert M.;Bucaloiu, Ion D.;Yahya, Taher
背景和目的估计GFR （eGFR）下降对死亡率的影响主要集中在肾功能正常的人群中，或者包括先前显示影响CKD患者死亡风险的因素的有限信息。设计、环境、参与者和测量我们回顾性评估了2004年1月1日至2009年12月31日期间，通过宾夕法尼亚州中部一个大型综合医疗保健系统接受初级保健的慢性肾病患者eGFR下降率对生存率的影响。结果共随访15465例患者，中位随访3.4年。eGFR斜坡下、中、上三分位的eGFR变化中位数分别为-4.8、-0.6和3.5 ml/min / 1.73 m(2)/yr。在死亡时间的Cox比例风险模型中，校正了基线蛋白尿、营养参数的变化和随访期间急性肾损伤的发作（以及其他协变量），eGFR水平较低（下降）和较高（增加）的各组（相对于中等或稳定的各组）的风险比分别为1.84和1.42。营养状况的纵向变化以及急性肾损伤的发作仅轻微地降低了风险。这些发现在各个亚组中是一致的。结论：eGFR随时间变化为CKD患者的传统死亡风险预测指标增加了预后信息。应进一步研究将eGFR趋势纳入患者风险评估的效用。中华临床医学杂志，2011,31(6):579 - 586。doi: 10.2215 / CJN.00470111
Background and objectives Estimates of the effect of estimated GFR (eGFR) decline on mortality have focused on populations with normal kidney function, or have included limited information on factors previously shown to influence the risk of death among patients with CKD.Design, setting, participants, & measurements We retrospectively assessed the effect of rate of eGFR decline on survival of patients with CKD receiving primary care through a large integrated health care system in central Pennsylvania between January 1, 2004, and December 31, 2009.Results A total of 15,465 patients were followed for a median of 3.4 years. Median rates of eGFR change by those in the lower, middle, and upper tertiles of eGFR slope were -4.8, -0.6, and 3.5 ml/min per 1.73 m(2)/yr, respectively. In Cox proportional hazard modeling for time to death, adjusted for baseline proteinuria, changes in nutritional parameters, and episodes of acute kidney injury during follow-up (among other covariates), the hazard ratio for those in the lower (declining) and upper (increasing) eGFR tertiles (relative to the middle, or stable, tertile) was 1.84 and 1.42, respectively. Longitudinal changes in nutritional status as well as episodes of acute kidney injury attenuated the risk only modestly. These findings were consistent across subgroups.Conclusions eGFR change over time adds prognostic information to traditional mortality risk predictors among patients with CKD. The utility of incorporating eGFR trends into patient-risk assessment should be further investigated. Clin J Am Soc Nephrol 6: 1879-1886, 2011. doi: 10.2215/CJN.00470111