Glynn Liam G, Reddan Donal, Newell John, Hinde John, Buckley Brian, Murphy Andrew W
Department of General Practice, National University of Ireland, Galway, and Department of Medicine, University College Hospital, Ireland.
Nephrol Dial Transplant. 2007 Sep;22(9):2586-94. doi: 10.1093/ndt/gfm222. Epub 2007 Apr 23.
The importance of chronic kidney disease as an independent risk factor for morbidity and mortality in patients with cardiovascular disease in the community is not widely recognized.
A retrospective cohort study based in the West of Ireland followed a randomized practice-based sample of patients with cardiovascular disease. A database of 1609 patients with established cardiovascular disease was established in 2000. This was generated from a randomized sample of 35 general practices in the West of Ireland. The primary endpoint was a cardiovascular composite endpoint, which included death from a cardiovascular cause or any of the cardiovascular events of myocardial infarction (MI), heart failure, peripheral vascular disease and stroke. The secondary endpoint was death from any cause.
Of the original community-based cohort of 1609 patients with cardiovascular disease, 1272 (79%) had one or more serum creatinine measurements during the study period and 31 (1.9%) patients were lost to follow-up. Median follow-up was 2.90 years (SD 1.47) and the risk of the cardiovascular composite endpoint (total of 219 events) was significantly increased in those patients with reduced estimated glomerular filtration rate (GFR) [log rank (Mantel-Cox) 26.74, P<0.001] as was the risk of death from any cause (total of 214 deaths) [Log Rank (Mantel-Cox) 56.97, P<0.001]. On the basis of the proportional hazards model, while adjusting for other significant covariates, reduced estimated GFR was associated with a significant increase in risk of the primary and secondary outcomes (P<0.01). For every 10 ml decrement in estimated GFR there was a corresponding 20% increase in hazard of the cardiovascular composite endpoint and a 33% increase in hazard of death from any cause.
Estimated GFR appears to discriminate prognosis between patients with established cardiovascular disease. These results emphasise the importance of recognising chronic kidney disease as a significant risk factor in patients with cardiovascular disease in the community.
慢性肾脏病作为社区心血管疾病患者发病和死亡的独立危险因素，其重要性尚未得到广泛认可。
一项基于爱尔兰西部的回顾性队列研究追踪了一组基于实践的心血管疾病患者随机样本。2000年建立了一个包含1609例确诊心血管疾病患者的数据库。该数据库来自爱尔兰西部35家全科诊所的随机样本。主要终点是心血管复合终点，包括心血管原因导致的死亡或心肌梗死（MI）、心力衰竭、外周血管疾病和中风等任何心血管事件。次要终点是任何原因导致的死亡。
在最初基于社区的1609例心血管疾病队列中，1272例（79%）在研究期间进行了一次或多次血清肌酐测量，31例（1.9%）患者失访。中位随访时间为2.90年（标准差1.47），估计肾小球滤过率（GFR）降低的患者发生心血管复合终点（共219例事件）的风险显著增加[对数秩（曼特尔 - 考克斯）26.74，P<0.001]，任何原因导致的死亡风险（共214例死亡）也显著增加[对数秩（曼特尔 - 考克斯）56.97，P<0.001]。基于比例风险模型，在调整其他显著协变量后，估计GFR降低与主要和次要结局风险的显著增加相关（P<0.01）。估计GFR每降低10 ml，心血管复合终点的风险相应增加20%，任何原因导致的死亡风险增加33%。
估计GFR似乎可以区分已确诊心血管疾病患者的预后。这些结果强调了将慢性肾脏病视为社区心血管疾病患者重要危险因素的重要性。
