CKD classification based on estimated GFR over three years and subsequent cardiac and mortality outcomes: a cohort study.
CKD classification based on estimated GFR over three years and subsequent cardiac and mortality outcomes: a cohort study.
复制标题
DOI：
10.1186/1471-2369-10-26
复制
发表时间：
2009-09-17
期刊：
影响因子：
2.3
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Weiner DE;Krassilnikova M;Tighiouart H;Salem DN;Levey AS;Sarnak MJ
目前尚不清楚基于1次或2次肾小球滤过率（eGFR）评估来定义慢性肾脏疾病（CKD）是否会改变eGFR降低在社区人群中的预后重要性。社区动脉粥样硬化风险研究和心血管健康研究的参与者根据两个eGFR评估分为4组，间隔35.3±2.5个月：持续eGFR < 60 mL/min / 1.73 m2 (1 mL/sec / 1.73 m2)；eGFR升高（从低于60变为高于60）；eGFR下降（从60以上变为60以下）；eGFR持续≥60。在分层多变量Cox模型中评估的结果包括心脏事件和心脏事件、中风和死亡率的组合。891名（4.9%）参与者持续eGFR < 60, 278名（1.5%）参与者持续eGFR升高，972名（5.4%）参与者持续eGFR下降，15925名（88.2%）参与者持续eGFR低于60。eGFR持续< 60的参与者心脏和复合事件的风险最高[HR分别= 1.38（1.15,1.65）和1.58(1.41,1.77)]，其次是eGFR下降[HR = 1.20（1.00, 1.45）和1.32(1.17,1.49)]。eGFR升高的个体有增加心脏风险的趋势[HR = 1.25(0.88, 1.77)]，在任何结果上与eGFR下降没有显著差异。当用CKD-EPI方程估计GFR时，结果相似。eGFR持续降低的个体心血管结局和死亡风险最高，而任何时候eGFR < 60 mL/min / 1.73 m2的个体处于中等风险。在社区人群中，使用单一的eGFR测量来分类CKD似乎具有预后价值。
It is unknown whether defining chronic kidney disease (CKD) based on one versus two estimated glomerular filtration rate (eGFR) assessments changes the prognostic importance of reduced eGFR in a community-based population. Participants in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study were classified into 4 groups based on two eGFR assessments separated by 35.3 ± 2.5 months: sustained eGFR < 60 mL/min per 1.73 m2 (1 mL/sec per 1.73 m2); eGFR increase (change from below to above 60); eGFR decline (change from above to below 60); and eGFR persistently ≥60. Outcomes assessed in stratified multivariable Cox models included cardiac events and a composite of cardiac events, stroke, and mortality. There were 891 (4.9%) participants with sustained eGFR < 60, 278 (1.5%) with eGFR increase, 972 (5.4%) with eGFR decline, and 15,925 (88.2%) with sustained eGFR > 60. Participants with eGFR sustained < 60 were at highest risk of cardiac and composite events [HR = 1.38 (1.15, 1.65) and 1.58 (1.41, 1.77)], respectively, followed by eGFR decline [HR = 1.20 (1.00, 1.45) and 1.32 (1.17, 1.49)]. Individuals with eGFR increase trended toward increased cardiac risk [HR = 1.25 (0.88, 1.77)] and did not significantly differ from eGFR decline for any outcome. Results were similar when estimating GFR with the CKD-EPI equation. Individuals with persistently reduced eGFR are at highest risk of cardiovascular outcomes and mortality, while individuals with an eGFR < 60 mL/min per 1.73 m2 at any time are at intermediate risk. Use of even a single measurement of eGFR to classify CKD in a community population appears to have prognostic value.