Department of Nephrology, University Hospital of North Norway, Tromsø, Norway.
Nephron Clin Pract. 2010;115(1):c41-50. doi: 10.1159/000286349. Epub 2010 Feb 19.
BACKGROUND/AIM: A high percentage of patients with chronic kidney disease has nonprogressive disease. Classification with respect to rate of change in glomerular filtration rate (GFR) would permit a more targeted approach to these patients. The aim of this study was to study predictors of rate of change in GFR in a population-based cohort.
All prevalent patients with chronic kidney disease stage 3 in a well-defined population in Northern Europe between 1994 and 2003 were included. Clinical and biochemical data were collected from primary care and hospital medical records. GFR was estimated from creatinine with the recalibrated Modification of Diet in Renal Disease Study equation. Rate of change in GFR were explored in two-level multivariate linear regression models.
A total of 1,224 patients were included. The mean age (76.5 years) was higher and mean rate of decline in GFR slower (1.5 ml/min/1.73 m(2)/year) than in studies of selected patient groups. A total of 60% of the patients suffered from comorbid conditions, 90% had hypertension. Male gender, diabetes, proteinuria and higher mean arterial pressure were independent predictors of a faster decline in GFR.
The similarity of the identified predictors with those found in clinical trials of more selected patients may indicate the potential for improved treatment of older chronic kidney disease patients with multiple comorbidities by better adherence to existing guidelines.
背景/目的：相当比例的慢性肾脏病患者的疾病无进展。基于肾小球滤过率（GFR）变化率的分类可以使这些患者得到更有针对性的治疗。本研究旨在研究人群中 GFR 变化率的预测因素。
在北欧，1994 年至 2003 年间，在一个明确界定的人群中纳入所有慢性肾脏病 3 期的现患患者。临床和生化数据来自初级保健和医院病历。GFR 用经过重新校准的肾脏病饮食改良研究方程计算肌酐得出。在两级多元线性回归模型中探讨 GFR 的变化率。
共纳入 1224 例患者。与选定患者组的研究相比，患者的平均年龄（76.5 岁）较高，GFR 下降速度较慢（1.5ml/min/1.73m(2)/year）。60%的患者患有合并症，90%的患者患有高血压。男性、糖尿病、蛋白尿和较高的平均动脉压是 GFR 下降较快的独立预测因素。
与临床试验中更具选择性的患者发现的预测因素相似，可能表明通过更好地遵循现有指南，对患有多种合并症的老年慢性肾脏病患者进行治疗，可能会有所改善。
