van Gestel Yvette R B M, Chonchol Michel, Hoeks Sanne E, Welten Gijs M J M, Stam Henk, Mertens Frans W, van Domburg Ron T, Poldermans Don
Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Nephrol Dial Transplant. 2009 Sep;24(9):2763-7. doi: 10.1093/ndt/gfp171. Epub 2009 Apr 15.
Chronic obstructive pulmonary disease (COPD) is recognized as a source of systemic inflammation and is associated with the development of cardiovascular disease. However, little is known about the association between COPD and chronic kidney disease (CKD). Therefore, we investigated the relationship between COPD and CKD and the association between COPD and mortality in patients with CKD.
We conducted a cohort study of 3358 vascular surgery patients between 1990 and 2006. CKD was defined according to the Modification of Diet in Renal Disease equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). In addition, the patients were divided into three categories based on the baseline estimated GFR: > or =90 mL/min/1.73 m(2); 60-89 mL/min/1.73 m(2) and <60 mL/min/1.73 m(2). Multivariable logistic regression analysis was used to evaluate the independent association between prevalent COPD and CKD.
The prevalence of COPD was inversely related to kidney function. COPD was present in 47, 38 and 32% of patients with an estimated GFR <60, 60-89 and > or =90 mL/min/1.73 m(2), respectively. COPD was independently associated with CKD (OR 1.22; 95% CI 1.03-1.44; P = 0.03). This association was strongest in patients with moderate COPD (OR 1.33; 95% CI 1.07-1.65; P = 0.01). Both moderate and severe COPD were associated with increased long-term mortality in patients with CKD (HR 1.27; 95% CI 1.03-1.56; P = 0.03 and HR 1.61; 95% CI 1.10-2.35; P = 0.01, respectively), compared to patients without COPD.
Our findings indicate that COPD is moderately associated with CKD in a large cohort of vascular surgery patients. In addition, moderate and severe COPD are related to increased long-term mortality in patients with CKD.
慢性阻塞性肺疾病（COPD）被认为是全身炎症的一个来源，并且与心血管疾病的发生有关。然而，关于COPD与慢性肾脏病（CKD）之间的关联知之甚少。因此，我们调查了COPD与CKD之间的关系以及COPD与CKD患者死亡率之间的关联。
我们对1990年至2006年间的3358例血管外科患者进行了一项队列研究。根据肾脏病饮食改良公式将CKD定义为估计肾小球滤过率（GFR）<60 mL/（min·1.73 m²）。此外，根据基线估计的GFR将患者分为三类：≥90 mL/（min·1.73 m²）；60 - 89 mL/（min·1.73 m²）和<60 mL/（min·1.73 m²）。采用多变量逻辑回归分析来评估现患COPD与CKD之间的独立关联。
COPD的患病率与肾功能呈负相关。估计GFR<60、60 - 89和≥90 mL/（min·1.73 m²）的患者中，COPD的患病率分别为47%、38%和32%。COPD与CKD独立相关（比值比1.22；95%置信区间1.03 - 1.44；P = 0.03）。这种关联在中度COPD患者中最强（比值比1.33；95%置信区间1.07 - 1.65；P = 0.01）。与无COPD的患者相比，中度和重度COPD均与CKD患者的长期死亡率增加相关（风险比分别为1.27；95%置信区间1.03 - 1.56；P = 0.03和1.61；9,5%置信区间1.10 - 2.35；P = 0.01）。
我们的研究结果表明，在一大群血管外科患者中，COPD与CKD中度相关。此外，中度和重度COPD与CKD患者的长期死亡率增加有关。
