Levin A, Djurdjev O, Barrett B, Burgess E, Carlisle E, Ethier J, Jindal K, Mendelssohn D, Tobe S, Singer J, Thompson C
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Kidney Dis. 2001 Dec;38(6):1398-407. doi: 10.1053/ajkd.2001.29275.
The high prevalence of cardiovascular disease (CVD) in patients with kidney disease is well described. This Canadian, multicenter, observational cohort study reports the prevalence and risk factors of CVD associated with kidney disease, in a cohort of patients with established chronic kidney disease (CKD), who are followed-up by nephrologists. This analysis sought to answer 2 questions: (1) in patients with established CKD, are the prevalence and progression of CVD accounted for by conventional or uremia-related risk factors, and (2) to what extent can progression to renal replacement therapy (RRT) be explained by CVD versus traditional risk factors for kidney disease? This study population consists of 313 patients (predominantly men) who had a mean age of 56 years and a mean creatinine clearance of 36 mL/min. Thirty percent were diabetic. The overall prevalence of CVD was 46%, and was independent of severity of kidney dysfunction (P = 0.700). The median follow-up time was 23 months, for a total of 462 patient years. We note the overall incidence of CVD events (new CVD or worsening of CVD) was 47/244 (20%). The best predictors of new CVD events among those without preexisting CVD were diabetes (odds ratio [OR] = 5.35, P = 0.018) and age (OR = 1.26, P = 0.08). In those with preexisting CVD, low diastolic pressure (DP) (OR =.72, P = 0.004) and high triglycerides (OR = 1.48, P = 0.019) at baseline were independent predictors of progression of CVD. We could not determine an independent impact of kidney function on CVD in the overall cohort. Furthermore, we determined that the presence of CVD itself confers an increased risk for progression to RRT (relative risk [RR] = 1.58, P = 0.047), adjusted for kidney function. This is the first in-depth analysis of CVD in a cohort of patients with established chronic kidney disease who are not on dialysis. The question regarding the impact of the altered biology of uremia in contributing to CVD progression remains unanswered, and clearly needs further study. However, the findings do raise the issue of whether aggressive treatment of CVD and risk factors might, in fact, reduce progression to RRT. Further large-scale, observational studies as well as interventional studies are needed to more clearly understand the complex biology of cardiovascular and kidney disease progression.
肾病患者中心血管疾病（CVD）的高患病率已得到充分描述。这项加拿大多中心观察性队列研究报告了在一组由肾病科医生随访的已确诊慢性肾脏病（CKD）患者中，与肾病相关的CVD患病率及危险因素。该分析旨在回答两个问题：（1）在已确诊CKD的患者中，CVD的患病率和进展是由传统危险因素还是与尿毒症相关的危险因素所致；（2）CVD与传统肾病危险因素相比，在多大程度上可以解释向肾脏替代治疗（RRT）的进展？本研究人群包括313例患者（以男性为主），平均年龄56岁，平均肌酐清除率为36 mL/分钟。30%为糖尿病患者。CVD的总体患病率为46%，且与肾功能不全的严重程度无关（P = 0.700）。中位随访时间为23个月，总计462患者年。我们注意到CVD事件（新发CVD或CVD恶化）的总体发生率为47/244（20%）。在无既往CVD的患者中，新发CVD事件的最佳预测因素是糖尿病（比值比[OR]=5.35，P = 0.018）和年龄（OR = 1.26，P = 0.08）。在有既往CVD的患者中，基线时低舒张压（DP）（OR = 0.72，P = 0.004）和高甘油三酯（OR = 1.48，P = 0.019）是CVD进展的独立预测因素。在整个队列中，我们无法确定肾功能对CVD的独立影响。此外，我们确定，在调整肾功能后，CVD本身的存在会增加进展至RRT的风险（相对风险[RR]=1.58，P = 0.047）。这是对一组未接受透析的已确诊慢性肾脏病患者的CVD进行的首次深入分析。关于尿毒症生物学改变对CVD进展的影响问题仍未得到解答，显然需要进一步研究。然而，这些发现确实提出了一个问题，即积极治疗CVD及其危险因素是否实际上可以减少向RRT的进展。需要进一步的大规模观察性研究以及干预性研究，以更清楚地了解心血管疾病和肾脏疾病进展的复杂生物学机制。
