在VALUE试验的高危高血压人群中，通过估算肾小球滤过率和估算肌酐清除率预测心血管结局

Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial.

作者信息

Ruilope Luis M, Zanchetti Alberto, Julius Stevo, McInnes Gordon T, Segura Julian, Stolt Pelle, Hua Tsushung A, Weber Michael A, Jamerson Ken

机构信息

Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.

出版信息

J Hypertens. 2007 Jul;25(7):1473-9. doi: 10.1097/HJH.0b013e328133246c.

DOI:10.1097/HJH.0b013e328133246c

PMID:17563571

Abstract

BACKGROUND

Reduced renal function is predictive of poor cardiovascular outcomes but the predictive value of different measures of renal function is uncertain.

METHODS

We compared the value of estimated creatinine clearance, using the Cockcroft-Gault formula, with that of estimated glomerular filtration rate (GFR), using the Modification of Diet in Renal Disease (MDRD) formula, as predictors of cardiovascular outcome in 15 245 high-risk hypertensive participants in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. For the primary end-point, the three secondary end-points and for all-cause death, outcomes were compared for individuals with baseline estimated creatinine clearance and estimated GFR < 60 ml/min and > or = 60 ml/min using hazard ratios and 95% confidence intervals. Coronary heart disease, left ventricular hypertrophy, age, sex and treatment effects were included as covariates in the model.

RESULTS

For each end-point considered, the risk in individuals with poor renal function at baseline was greater than in those with better renal function. Estimated creatinine clearance (Cockcroft-Gault) was significantly predictive only of all-cause death [hazard ratio = 1.223, 95% confidence interval (CI) = 1.076-1.390; P = 0.0021] whereas estimated GFR was predictive of all outcomes except stroke. Hazard ratios (95% CIs) for estimated GFR were: primary cardiac end-point, 1.497 (1.332-1.682), P < 0.0001; myocardial infarction, 1.501 (1.254-1.796), P < 0.0001; congestive heart failure, 1.699 (1.435-2.013), P < 0.0001; stroke, 1.152 (0.952-1.394) P = 0.1452; and all-cause death, 1.231 (1.098-1.380), P = 0.0004.

CONCLUSION

These results indicate that estimated glomerular filtration rate calculated with the MDRD formula is more informative than estimated creatinine clearance (Cockcroft-Gault) in the prediction of cardiovascular outcomes.

摘要

背景

肾功能减退预示着不良的心血管结局，但不同肾功能测量指标的预测价值尚不确定。

方法

在缬沙坦抗高血压长期应用评估（VALUE）试验的15245名高危高血压参与者中，我们比较了使用Cockcroft-Gault公式估算的肌酐清除率与使用肾脏病饮食改良（MDRD）公式估算的肾小球滤过率（GFR）作为心血管结局预测指标的价值。对于主要终点、三个次要终点以及全因死亡，使用风险比和95%置信区间比较基线估算肌酐清除率和估算GFR<60 ml/分钟以及≥60 ml/分钟的个体的结局。冠心病、左心室肥厚、年龄、性别和治疗效果作为协变量纳入模型。

结果

对于所考虑的每个终点，基线时肾功能差的个体的风险高于肾功能较好的个体。估算肌酐清除率（Cockcroft-Gault）仅对全因死亡有显著预测作用[风险比=1.223，95%置信区间（CI）=1.076 - 1.390；P = 0.0021]，而估算GFR对除中风外的所有结局均有预测作用。估算GFR的风险比（95% CI）为：主要心脏终点，1.497（1.332 - 1.682），P < 0.0001；心肌梗死，1.501（1.254 - 1.796），P < 0.0001；充血性心力衰竭，1.699（1.435 - 2.013），P < 0.0001；中风，1.152（0.952 - 1.394），P = 0.1452；全因死亡，1.231（1.098 - 1.380），P = 0.0004。