Agarwal Rajiv, Bunaye Zerihun, Bekele Dagim M, Light Robert P
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
Am J Nephrol. 2008;28(4):569-75. doi: 10.1159/000115291. Epub 2008 Feb 1.
Death and dialysis are competing outcomes in patients with chronic kidney disease (CKD). The factors associated with end-stage renal disease (ESRD) versus death in this population are unknown. The purpose of our study was to evaluate the competing risk of ESRD versus mortality and to evaluate the risk factors associated with these two outcomes.
We prospectively recruited 220 consecutive patients at a Veterans Administration Medical Center attending a renal clinic who met the definition of CKD (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) or urine protein/creatinine ratio of >0.22 g/g). Using age, race, proteinuria, eGFR, systolic blood pressure, and coronary artery disease as predictors, we calculated the competing end-points of ESRD or death using a competing Cox regression model.
The cumulative incidence for ESRD was 17.6% and death 18.5% during follow-up that lasted up to 7 years. ESRD was predicted by younger age (hazard ratio (HR) 0.91/year), black race (HR 2.75), higher systolic blood pressure (HR 1.02/mm Hg), proteinuria (HR 1.37/log urine protein/creatinine ratio) and low eGFR (0.014/log eGFR ml/min/1.73 m(2)). Death was predicted by older age (HR 1.07/year), lower eGFR (HR 0.43/log eGFR ml/min/1.73 m(2)), proteinuria (HR 1.26/log urine protein/creatinine ratio) and coronary artery disease (HR 2.52). The coefficients were statistically different for age (p < 0.001), log eGFR (p < 0.001) and systolic blood pressure (p = 0.04) for ESRD and death outcomes.
The risk for mortality is similar to the risk of ESRD in the CKD population of veterans seen by nephrologists. Risk factors for ESRD and death appear to differ in this population. Certain clinical and demographic factors may discriminate between the end-points of death or dialysis and may influence decisions about planning for ESRD.
在慢性肾脏病（CKD）患者中，死亡和透析是相互竞争的结局。该人群中与终末期肾病（ESRD）和死亡相关的因素尚不清楚。我们研究的目的是评估ESRD与死亡的竞争风险，并评估与这两种结局相关的危险因素。
我们在一家退伍军人事务医疗中心的肾脏门诊前瞻性地连续招募了220例符合CKD定义（估计肾小球滤过率（eGFR）<60 ml/min/1.73 m²或尿蛋白/肌酐比值>0.22 g/g）的患者。以年龄、种族、蛋白尿、eGFR、收缩压和冠状动脉疾病作为预测因素，我们使用竞争Cox回归模型计算ESRD或死亡的竞争终点。
在长达7年的随访期间，ESRD的累积发病率为17.6%，死亡的累积发病率为18.5%。ESRD的预测因素包括年轻（风险比（HR）0.91/年）、黑人种族（HR 2.75）、较高的收缩压（HR 1.02/mmHg）、蛋白尿（HR 1.37/对数尿蛋白/肌酐比值）和低eGFR（0.014/对数eGFR ml/min/1.73 m²）。死亡的预测因素包括老年（HR 1.07/年）、较低的eGFR（HR 0.43/对数eGFR ml/min/1.73 m²）、蛋白尿（HR 1.26/对数尿蛋白/肌酐比值）和冠状动脉疾病（HR 2.52）。ESRD和死亡结局在年龄（p<0.001）、对数eGFR（p<0.001）和收缩压（p = 0.04）方面的系数有统计学差异。
在肾病学家诊治的退伍军人CKD人群中，死亡风险与ESRD风险相似。ESRD和死亡的危险因素在该人群中似乎有所不同。某些临床和人口统计学因素可能会区分死亡或透析的终点，并可能影响ESRD规划决策。
