Division of Nephrology, Department of Medicine, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Nephrol Dial Transplant. 2010 Jun;25(6):1846-53. doi: 10.1093/ndt/gfp729. Epub 2010 Jan 6.
Chronic kidney disease is a growing public health problem worldwide. Previous studies have identified several predictors for renal function decline. However, these studies used a single measurement of these risk factors. Therefore, the aim of this study was to investigate whether besides the baseline values of these risk factors, changes in risk factors are associated with subsequent rate of renal function loss.
Five thousand, six hundred and fifty-one participants in the Prevention of Renal and Vascular ENd-stage Disease (PREVEND) Study, a prospective, community-based cohort study, completed three screening visits during a follow-up of 6.5 years for detailed clinical and biochemical measurements. Change in renal function between the second and third screening rounds was chosen as the study parameter of interest. Changes in risk factors between the first and second screening rounds were incorporated as potential predictors for renal function loss in multivariable linear regression analyses. Based on the results of a previous study, gender-specific analyses were performed.
In males, an increase in urinary albumin excretion (UAE), systolic blood pressure (SBP) and cholesterol was associated with a subsequent higher rate of renal function loss, whereas in females, increases in glucose levels were associated with an increase in renal function. For males, the analyses showed that both the baseline values and the change in UAE and cholesterol were significant predictors for increased rate of renal function loss during subsequent follow-up. With respect to SBP, when taking also the change in this variable into account, the baseline value was no longer a significant predictor for renal function loss.
The results of the present study show the value of screening programs including repeated measurements of risk factors. Furthermore, these data indicate that, besides baseline values of risk factors, the changes over time in these factors should also be taken into account when developing 'Renal Risk Scores' to identify subjects in the general population who are at risk for accelerated renal function deterioration.
慢性肾脏病是全球日益严重的公共卫生问题。先前的研究已经确定了一些肾功能下降的预测因素。然而，这些研究仅使用了这些危险因素的单次测量值。因此，本研究旨在探讨除了这些危险因素的基线值外，危险因素的变化是否与随后的肾功能丧失速度有关。
在预防肾脏和血管终末期疾病（PREVEND）研究中，有 5651 名参与者是前瞻性的社区队列研究，在 6.5 年的随访期间完成了三次筛查访问，以进行详细的临床和生化测量。选择第二次和第三次筛查之间的肾功能变化作为研究的感兴趣参数。将第一次和第二次筛查之间的危险因素变化纳入多变量线性回归分析，作为肾功能丧失的潜在预测因素。基于之前研究的结果，进行了性别特异性分析。
在男性中，尿白蛋白排泄率（UAE）、收缩压（SBP）和胆固醇的增加与随后肾功能丧失速度加快相关，而在女性中，血糖水平的增加与肾功能的增加相关。对于男性，分析表明，UAE 和胆固醇的基线值和变化均是随后随访中肾功能丧失速度加快的显著预测因素。对于 SBP，当同时考虑到该变量的变化时，基线值不再是肾功能丧失的显著预测因素。
本研究的结果表明，包括重复测量危险因素在内的筛查计划具有价值。此外，这些数据表明，除了危险因素的基线值外，还应考虑这些因素随时间的变化，以便在制定“肾脏风险评分”以识别一般人群中肾功能恶化风险增加的个体时，将其纳入考虑。
