Serviço de Nefrologia, Hospital de Faro, Rua Leão Penedo, 8000, Faro, Portugal.
Int Urol Nephrol. 2010 Mar;42(1):173-9. doi: 10.1007/s11255-009-9634-x. Epub 2009 Sep 11.
The increased mortality rate observed in patients with chronic kidney disease is related to the high prevalence of cardiovascular disease in this population. Recently, it has been shown that interventional therapy with statins and/or vitamin D could improve the outcomes of these patients. The aim of this study was to identify the risk factors for mortality in a group of patients with chronic kidney disease (stages 4 and 5--pre-dialysis) and verify whether vitamin D and statins could change the outcome. We included 95 patients (mean age--69.4) with stages 4 and 5 (pre-dialysis) of our "low-clearance" outpatient clinic, with an average eGFR of 16.9 ml/min and a mean follow-up of 24.1 months. Several biological, nutritional, laboratory and inflammatory parameters were analysed at baseline. Our population was divided into three groups: G-I, patients not medicated with either vitamin D or statins; G-II, patients medicated with either vitamin D or statins; and G-III, patients medicated with vitamin D and statins. We found (ANOVA) that the serum levels of pre-albumin (P = 0.018) and PTH (P = 0.03) were lower in G-I. Concerning the inflammatory parameters, G-I showed higher levels of hsCRP (P = 0.014) and a trend to higher IL-6 levels (P = 0.077). We found the actuarial survival at 30 months (Kaplan-Meier), to be 56.4% in G-I, 82.3% in G-II and 100% in G-III (log rank = 13.08 P = 0.0014). Using the Cox proportional hazards model, we found that the existence of coronary artery disease (P = 0.0001) and the absence of medication with vitamin D and/or statins (P = 0.005) independently influenced the mortality of our patients. In conclusion, we found, in our study, that patients under vitamin D and statins (with a synergistic effect) were less inflamed and showed a lower mortality rate.
本研究旨在确定一组慢性肾脏病（4 期和 5 期-透析前）患者的死亡风险因素，并验证维生素 D 和他汀类药物是否可以改变预后。我们纳入了 95 名来自我们的“低清除率”门诊患者的 4 期和 5 期（透析前）患者（平均年龄 69.4 岁），平均 eGFR 为 16.9ml/min，平均随访时间为 24.1 个月。在基线时分析了几种生物学、营养、实验室和炎症参数。我们的人群分为三组：G-I 组，未接受维生素 D 或他汀类药物治疗的患者；G-II 组，接受维生素 D 或他汀类药物治疗的患者；G-III 组，接受维生素 D 和他汀类药物治疗的患者。我们发现（方差分析），G-I 组的血清前白蛋白水平（P=0.018）和 PTH 水平（P=0.03）较低。在炎症参数方面，G-I 组的 hsCRP 水平较高（P=0.014），IL-6 水平也有升高的趋势（P=0.077）。我们发现，30 个月时的累积生存率（Kaplan-Meier）在 G-I 组为 56.4%，在 G-II 组为 82.3%，在 G-III 组为 100%（对数秩检验=13.08，P=0.0014）。使用 Cox 比例风险模型，我们发现冠状动脉疾病的存在（P=0.0001）和缺乏维生素 D 和/或他汀类药物的治疗（P=0.005）独立影响了我们患者的死亡率。总之，我们在研究中发现，接受维生素 D 和他汀类药物治疗（具有协同作用）的患者炎症程度较低，死亡率较低。
