Keith Douglas S, Nichols Gregory A, Gullion Christina M, Brown Jonathan Betz, Smith David H
Division of Nephrology and Hypertension, Oregon Health and Science University, USA.
Arch Intern Med. 2004 Mar 22;164(6):659-63. doi: 10.1001/archinte.164.6.659.
Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population.
In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m(2) on 2 separate measurements at least 90 days apart. We followed up patients from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m(2) until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. We extracted from the computerized medical records the prevalence of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia.
Our data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages.
Our data suggest that efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.
在美国，慢性肾脏病是终末期肾病的主要病因。本研究旨在了解具有代表性的患者群体中慢性肾脏病进展至肾脏替代治疗（移植或透析）及死亡方面的自然病程。
1996年，我们在健康计划中确定了27998例患者，这些患者在至少间隔90天的两次独立测量中，估算肾小球滤过率低于90 mL/（min·1.73 m²）。我们从首次估算肾小球滤过率低于90 mL/（min·1.73 m²）的索引日期开始对患者进行随访，直至其接受肾脏替代治疗、死亡、退出健康计划或2001年6月30日。我们从计算机化医疗记录中提取了索引日期和终点时以下合并症的患病率：高血压、糖尿病、冠状动脉疾病、充血性心力衰竭、高脂血症和肾性贫血。
我们的数据显示，在5年观察期内，美国国家肾脏基金会肾脏病预后质量倡议（K/DOQI）2期、3期和4期患者的肾脏替代治疗率分别为1.1%、1.3%和19.9%，但死亡率分别为19.5%、24.3%和45.7%。因此，在所有阶段，死亡都远比透析更为常见。此外，充血性心力衰竭、冠状动脉疾病、糖尿病和贫血在死亡患者中更为普遍，但高血压患病率在所有阶段相似。
我们的数据表明，降低该人群死亡率的努力应集中在冠状动脉疾病、充血性心力衰竭、糖尿病和贫血的治疗及预防上。
