Estimating Time to ESRD Using Kidney Failure Risk Equations: Results From the African American Study of Kidney Disease and Hypertension (AASK)
Estimating Time to ESRD Using Kidney Failure Risk Equations: Results From the African American Study of Kidney Disease and Hypertension (AASK)
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DOI：
10.1053/j.ajkd.2014.07.026
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发表时间：
2015-03-01
影响因子：
13.2
通讯作者：
Appel, Lawrence J.
中科院分区：
文献类型：
--
作者：
Grams, Morgan E.;Li, Liang;Appel, Lawrence J.
背景：肾脏替代治疗的计划，如动静脉瘘放置和移植的转诊，通常以估计的肾小球滤过率(EGFR)水平为指导。风险方程的使用可能能够更准确地估计到终末期肾病(ESRD)的时间，从而改善患者护理。研究设计：前瞻性观察性研究。地点和对象：参加非裔美国人肾脏疾病和高血压研究(AASK)队列的1094名参与者。预测因素：年龄、性别、尿蛋白/肌酐比值和GT；结果：5个不同起点的ESRD累积发病率：EGFR分别为30和15毫升/分钟/1.73米(2)，1年ESRD风险分别为5%、10%和20%，根据已发表的四变量肾功能衰竭风险方程估计。结果：566名参与者发生了30毫升/分钟/1.73米(2)的EGFR，244人发生了15毫升/分钟/1.73米(2)的EGFR，437人、336人和259人1年内发生ESRD的风险为5%。分别为10%和20%。EGFR为30mL/min/1.73m(2)、EGFR为15mL/min/1.73m(2)、ESRD风险为5%、ESRD风险为10%、ESRD风险为20%时，1年内ESRD累积发病率分别为4.3%、49.0%、6.7%、15.0%和29%。根据EGFR为30mL/min/1.73m(2)，有几个危险因素可以预测终末期肾病的风险。EGFR为15mL/min/1.73m(2)时，只有蛋白尿水平有影响；高蛋白尿组和低蛋白尿组达到ESRD的中位时间分别为9个月和19个月。中位时间与相应的ESRD风险阈值的差异较小。例如，在蛋白尿量较高和较低的人群中，从20%的ESRD风险到ESRD的中位时间分别为22个月和25个月。限制：患有高血压肾脏疾病的非裔美国人中的相对同质性人群。结论：本研究的结果表明，将肾功能衰竭风险方程纳入临床护理中具有潜在的好处，并根据其预期用途选择特定的阈值。(C)2015年，由国家肾脏基金会公司提供。
Background: Planning for renal replacement therapy, such as referral for arteriovenous fistula placement and transplantation, often is guided by level of estimated glomerular filtration rate (eGFR). The use of risk equations might enable more accurate estimation of time to end-stage renal disease (ESRD), thus improving patient care. Study Design: Prospective observational study.Setting & Participants: 1,094 participants in the African American Study of Kidney Disease and Hypertension (AASK) cohort.Predictor: Age, sex, urine protein-creatinine ratio >= 1 g/g, APOL1 high-risk status, and 3-year antecedent eGFR decline.Outcome: Cumulative incidence of ESRD from 5 different starting points: eGFR of 30 and 15 mL/min/1.73 m(2) and 1-year ESRD risk of 5%, 10%, and 20%, estimated by a published 4-variable kidney failure risk equation.Results: 566 participants developed eGFR of 30 mL/min/1.73 m(2), 244 developed eGFR of 15 mL/min/ 1.73 m(2), and 437, 336, and 259 developed 1-year ESRD risks of 5%, 10%, and 20%, respectively. The 1-year cumulative incidence of ESRD was 4.3% from eGFR of 30 mL/min/1.73 m(2), 49.0% from eGFR of 15 mL/min/1.73 m(2), 6.7% from 5% ESRD risk, 15.0% from 10% ESRD risk, and 29% from 20% ESRD risk. From eGFR of 30 mL/min/1.73 m(2), there were several risk factors that predicted ESRD risk. From eGFR of 15 mL/min/1.73 m(2), only level of proteinuria did; median time to ESRD was 9 and 19 months in those with higher and lower proteinuria, respectively. Median times were less variable from corresponding ESRD risk thresholds. For example, median times to ESRD from 20% ESRD risk were 22 and 25 months among those with higher and lower proteinuria, respectively.Limitations: Relatively homogeneous population of African Americans with hypertensive kidney disease.Conclusions: Results of the present study suggest the potential benefit of incorporating kidney failure risk equations into clinical care, with selection of a specific threshold guided by its intended use. (C) 2015 by the National Kidney Foundation, Inc.