Past Decline Versus Current eGFR and Subsequent Mortality Risk
Past Decline Versus Current eGFR and Subsequent Mortality Risk
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DOI：
10.1681/asn.2015060688
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发表时间：
2016-08-01
影响因子：
13.6
通讯作者：
de Jong, Paul E.
中科院分区：
文献类型：
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作者：
Naimark, David M. J.;Grams, Morgan E.;de Jong, Paul E.
单项测定EGFR与随后的死亡风险相关。既往EGFR下降提示肾功能丧失，但与死亡风险的关系尚不确定。我们对既往EGFR斜率相关的死亡风险进行了个体水平的荟萃分析，调整了已确定的风险因素，包括最后一次EGFR，受试者来自12个CKD和CKD预后联盟内的其他22个队列中的120万人。在之前的3年时间里，CKD组和其他队列中分别有12%和11%的参与者有EGFR斜率，分别为每年每1.73m(2)5毫升/分钟。与每年每1.73米(2)的斜率为0毫升/分钟相比，在3.2年的随访中，每1.73米(2)的斜率为-6毫升/分钟，调整后的全因死亡率风险比在慢性肾脏病队列中为1.25(95%可信区间[95%可信区间]，1.09至1.44)，在其他队列中为1.15(95%可信区间，1.01至1.31)。每年每1.73m(2)的斜率+6ml/min也与更高的全因死亡风险相关，调整后的危险比在CKD队列中为1.58(95%可信区间，1.29至1.95)，在其他队列中为1.43(95%可信区间，1.11至1.84)。心血管和非心血管死亡原因的结果相似，且在较长时间内更强(3比
A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope, 5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m(2) per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus