Department of Nephrology, Rinku General Medical Center, Izumisano 598-8577, Japan.
Clin J Am Soc Nephrol. 2010 Sep;5(9):1558-65. doi: 10.2215/CJN.08061109. Epub 2010 Jun 17.
Population-based studies have reported outcomes and risk factors for patients with chronic kidney disease (CKD), defined primarily by decreased estimated GFR (eGFR). They are characterized by old age, low proteinuria level, and stage 3 CKD. However, many patients referred to nephrologists are younger and have overt proteinuria and advanced CKD. This study evaluated the association between outcomes and those factors among referred CKD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively reviewed 461 referred patients with stage 3 to 5 CKD from January 2003 to December 2007. Key outcomes were death and ESRD. Patients were followed from the time of first serum creatinine measurement to December 2009.
The median age of subjects was 67.0 years, and median follow-up was 3.2 years. Overt proteinuria was present in 57.0% of subjects. For stage 3, 4, and 5 CKD, cumulative mortality and probability of ESRD at 3 years was 9.5 and 6.5%, 11.2 and 27.8%, and 16.5 and 79.1%, respectively. Using proportional-hazards regression models, age was a determinant for death, whereas overt proteinuria was strongly associated with ESRD. Among stage 3 CKD patients older than 65 years without overt proteinuria, the incidence of death before renal replacement therapy (RRT) was 2.8/100 patient-years and none had ESRD. In patients with advanced CKD and overt proteinuria, the incidence of ESRD was substantially higher than that of death before RRT.
Stratification by age, proteinuria level, and CKD stage could predict the competing outcomes of death before RRT and ESRD among CKD patients.
基于人群的研究报告了慢性肾脏病（CKD）患者的结局和风险因素，这些患者主要通过估算肾小球滤过率（eGFR）降低来定义。他们的特点是年龄较大、蛋白尿水平较低且处于 CKD 第 3 期。然而，许多转介给肾病学家的患者年龄较轻，且存在显性蛋白尿和晚期 CKD。本研究评估了转介 CKD 患者的结局与这些因素之间的关联。
设计、地点、参与者和测量方法：我们回顾性分析了 2003 年 1 月至 2007 年 12 月期间的 461 例 3 至 5 期 CKD 患者。主要结局为死亡和终末期肾病（ESRD）。患者从首次血清肌酐测量时间开始随访至 2009 年 12 月。
受试者的中位年龄为 67.0 岁，中位随访时间为 3.2 年。57.0%的患者存在显性蛋白尿。对于 CKD 第 3、4 和 5 期，3 年时的累积死亡率和 ESRD 概率分别为 9.5%和 6.5%、11.2%和 27.8%、16.5%和 79.1%。使用比例风险回归模型，年龄是死亡的决定因素，而显性蛋白尿与 ESRD 密切相关。在年龄大于 65 岁且无显性蛋白尿的 CKD 第 3 期患者中，在接受肾脏替代治疗（RRT）之前死亡的发生率为 2.8/100 患者年，且无人发生 ESRD。在晚期 CKD 且存在显性蛋白尿的患者中，ESRD 的发生率远高于 RRT 之前的死亡率。
按年龄、蛋白尿水平和 CKD 分期分层可以预测 CKD 患者 RRT 前死亡和 ESRD 的竞争结局。
