Otero A, Abelleira A, Gayoso P
Servicio de Nefrología, Complexo Hospitalario de Ourense.
Nefrologia. 2005;25(3):275-87.
Vascular diseases are the first cause of mortality within the occidental world. In Spain, they represent 35.5% within the total of deceases. Vascular diseases, jointly with Diabetic Nephropaty, are the first cause of inclusion of patients in dialysis. In precocious stages of renal disease, and as a consequence of the inflammatory condition generated already exists vascular damage. But its prevention is difficult, because habitually GFR is evaluated by means of plasmatic creatinin rate impeding the suitable detection of renal disease prevailing.
The purpose of this study is to evaluate the prevailing of Occult Chronic Kidney Disease (OCKD) and its association with conventional vascular risk factors (VRF).
The epidemiologic study was made in a randomly selected population elder than 18 years. GFR was calculated using Cockcroft-Gault and MDRD methods, and the results were correlated with VRF.
The studied population mean age is 50.49 +/- 16.28 years, hypertension prevailing is 31.5%, diabetes: 7.5%, obesity: 21.9%, dislipènic: 35.62%, anemia: 1.4%. IV degree IRCO rate (GFR: 15-30 ml/min) is 0.7 (MDRD) with 69.43 +/- 12.58 years of age, and 1.5% (C-G) with 76.25 +/- 10.64 years of age. GFR, independently on the method used in its calculation, is significantly correlated with TAS (< 0.0001), pulse pressure (< 0.0001), Hb (0.0001), obesity (< 0.0001), Total Cholesterol (< 0.0001), triglycerides (< 0.0018), c-HDL (< 0.0001), c-LDL (< 0.0001) e hiperuricemic (< 0.0001). GFR disparity depends on the equation used. It could be explained because C-G overestimate by "weigh" and it has higher deviation in lower renal function values. Whereas, using MDRD equation there is an overestimation by "age" and it has lower variability.
In an aged population, the prevailing of OCKD and the rate of VRF are high conferring high vascular risk. It will be necessary to adopt intervention measures in order to avoid renal disease progress and its high morbid-mortality.
血管疾病是西方世界的首要死因。在西班牙，它们占总死亡人数的35.5%。血管疾病与糖尿病肾病共同构成患者接受透析的首要原因。在肾脏疾病的早期阶段，由于已经产生的炎症状态，血管损伤已然存在。但其预防困难，因为通常通过血浆肌酐率评估肾小球滤过率（GFR），这妨碍了对普遍存在的肾脏疾病的恰当检测。
本研究旨在评估隐匿性慢性肾脏病（OCKD）的流行情况及其与传统血管危险因素（VRF）的关联。
对随机选取的18岁以上人群进行流行病学研究。使用Cockcroft - Gault和MDRD方法计算GFR，并将结果与VRF进行关联分析。
研究人群的平均年龄为50.49±16.28岁，高血压患病率为31.5%，糖尿病为7.5%，肥胖为21.9%，血脂异常为35.62%，贫血为1.4%。IV级IRCO率（GFR：15 - 30 ml/分钟），采用MDRD方法时为0.7，年龄为69.43±12.58岁；采用C - G方法时为1.5%，年龄为76.25±10.64岁。无论计算GFR所使用的方法如何，GFR均与收缩压（<0.0001）、脉压（<0.0001）、血红蛋白（0.0001）、肥胖（<0.0001）、总胆固醇（<0.0001）、甘油三酯（<0.0018）、高密度脂蛋白胆固醇（<0.0001）、低密度脂蛋白胆固醇（<0.0001）和高尿酸血症（<0.0001）显著相关。GFR的差异取决于所使用的公式。这可以解释为，C - G公式通过“体重”进行高估，并且在较低肾功能值时偏差更大。而使用MDRD公式时，通过“年龄”进行高估，且变异性较小。
在老年人群中，OCKD的流行率和VRF的发生率较高，赋予了较高的血管风险。有必要采取干预措施以避免肾脏疾病进展及其高病死率。
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