Serrano Andres, Huang Jie, Ghossein Cybele, Nishi Laura, Gangavathi Anupama, Madhan Vijayachitra, Ramadugu Paramesh, Ahya Shubhada N, Paparello James, Khosla Neenoo, Schlueter William, Batlle Daniel
Division of Nephrology/Hypertension, Northwestern University, The Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL 60611, USA.
Adv Chronic Kidney Dis. 2007 Jan;14(1):105-12. doi: 10.1053/j.ackd.2006.07.009.
This study examines whether stabilization of the glomerular filtration rate (GFR) is possible in patients with advanced chronic kidney disease (CKD), managed in a CKD clinic. A cohort of 82 patients with stages 4 and 5 CKD was followed for a period of 2 years after initiation of erythropoietin for anemia to determine the GFR and the frequency of primary outcomes (dialysis, transplantation, or death). GFR, calculated by the abbreviated Modification of Diet in Renal Disease formula, was determined every 3 months. After 24 months, 35 subjects (43%) developed a primary outcome. Controlled for other risk factors, the risk of having a primary outcome increased 19.7% for every unit that the GFR decreased (95% confidence interval [CI], 11.9%-26.8%, P < .001) and decreased 21.7% for every unit that the hemoglobin increased (95% CI, 0.5%-38.4%, P < .001). Blacks had a 3.1 times higher risk (95% CI, 1.4-6.9, P = .006) of developing a primary outcome than other ethnicities. In subjects who did not develop primary outcomes (n = 47 or 57%), GFR remained unchanged (19.5 +/- 9.1 at the end of the study v 20.8 +/- 5.3 mL/min/1.73 m(2) at baseline, P = .16). The standardized mortality rate was 4.75 and 9.77 per 100 person-year for stages 4 and 5, respectively. We conclude that stabilization of GFR over a 2-year period can be achieved in many patients with advanced CKD treated with erythropoietin in a CKD clinic. Although the precise reason for the stabilization of GFR cannot be elucidated from this study, our data are "proof of concept" that CKD outcomes can be improved in a CKD clinic setting.
本研究探讨在慢性肾脏病（CKD）门诊管理的晚期慢性肾脏病患者中，肾小球滤过率（GFR）是否有可能实现稳定。对82例4期和5期CKD患者进行队列研究，在开始使用促红细胞生成素治疗贫血后随访2年，以确定GFR和主要结局（透析、移植或死亡）的发生频率。每3个月通过简化的肾脏病饮食改良公式计算一次GFR。24个月后，35名受试者（43%）出现了主要结局。在控制了其他风险因素后，GFR每降低一个单位，出现主要结局的风险增加19.7%（95%置信区间[CI]，11.9%-26.8%，P<.001），血红蛋白每增加一个单位，出现主要结局的风险降低21.7%（95%CI，0.5%-38.4%，P<.001）。黑人出现主要结局的风险是其他种族的3.1倍（95%CI，1.4-6.9，P=.006）。在未出现主要结局的受试者（n=47或57%）中，GFR保持不变（研究结束时为19.5±9.1，基线时为20.8±5.3 mL/min/1.73 m²，P=.16）。4期和5期的标准化死亡率分别为每100人年4.75和9.77。我们得出结论，在CKD门诊接受促红细胞生成素治疗的许多晚期CKD患者中，GFR可在2年内实现稳定。虽然本研究无法阐明GFR稳定的确切原因，但我们的数据是“概念验证”，表明在CKD门诊环境中可以改善CKD的结局。
