Menon V, Wang X, Sarnak M J, Hunsicker L H, Madero M, Beck G J, Collins A J, Kusek J W, Levey A S, Greene T
Department of Medicine, Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts, USA.
Kidney Int. 2008 Jun;73(11):1310-5. doi: 10.1038/ki.2008.67. Epub 2008 Mar 12.
The Modification of Diet in Renal Disease (MDRD) Study examined the effects of strict blood pressure control and dietary protein restriction on the progression of kidney disease. Here, we retrospectively evaluated outcomes of nondiabetic participants with stages 2-4 chronic kidney disease (CKD) from randomized and nonrandomized cohorts of the MDRD Study. Kidney failure and survival status through December of 2000, were obtained from the US Renal Data System and the National Death Index. Event rates were calculated for kidney failure, death, and a composite outcome of death and kidney failure. In the 1666 patients, rates for kidney failure were four times higher than that for death. Kidney failure was a more likely event than death in subgroups based on baseline glomerular filtration rate, proteinuria, kidney disease etiology, gender, and race. It was only among those older than 65 that the rate for death approximated that for kidney failure. In contrast to other populations with CKD, our study of relatively young subjects with nondiabetic disease has found that the majority of the participants advanced to kidney failure with a low competing risk of death. In such patients, the primary emphasis should be on delaying progression of kidney disease.
肾脏疾病饮食调整（MDRD）研究考察了严格血压控制和饮食蛋白质限制对肾脏疾病进展的影响。在此，我们回顾性评估了MDRD研究随机和非随机队列中2 - 4期慢性肾脏病（CKD）非糖尿病参与者的结局。通过美国肾脏数据系统和国家死亡指数获取了截至2000年12月的肾衰竭和生存状况。计算了肾衰竭、死亡以及死亡和肾衰竭复合结局的事件发生率。在这1666例患者中，肾衰竭发生率比死亡发生率高四倍。基于基线肾小球滤过率、蛋白尿、肾脏疾病病因、性别和种族的亚组分析中，肾衰竭比死亡更易发生。仅在65岁以上人群中，死亡发生率才接近肾衰竭发生率。与其他慢性肾脏病患者群体不同，我们对相对年轻的非糖尿病疾病患者的研究发现，大多数参与者进展至肾衰竭，且死亡的竞争风险较低。对于这类患者，主要重点应是延缓肾脏疾病进展。
