Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.
Am J Kidney Dis. 2010 Dec;56(6):1082-94. doi: 10.1053/j.ajkd.2010.07.016. Epub 2010 Oct 30.
Validated prediction scores are required to assess the risks of end-stage renal disease (ESRD) and death in individuals with chronic kidney disease (CKD).
Prospective cohort study with validation in a separate cohort.
SETTING & PARTICIPANTS: Cox regression was used to assess the relevance of baseline characteristics to risk of ESRD (mean follow-up, 4.1 years) and death (mean follow-up, 6.0 years) in 382 patients with stages 3-5 CKD not initially on dialysis therapy in the Chronic Renal Impairment in Birmingham (CRIB) Study. Resultant risk prediction equations were tested in a separate cohort of 213 patients with CKD (the East Kent cohort).
44 baseline characteristics (including 30 blood and urine assays).
ESRD and all-cause mortality.
In the CRIB cohort, 190 patients reached ESRD (12.1%/y) and 150 died (6.5%/y). Each 30% lower baseline estimated glomerular filtration rate was associated with a 3-fold higher ESRD rate and a 1.3-fold higher death rate. After adjustment for each other, only baseline creatinine level, serum phosphate level, urinary albumin-creatinine ratio, and female sex remained strongly (P < 0.01) predictive of ESRD. For death, age, N-terminal pro-brain natriuretic peptide, troponin T level, and cigarette smoking remained strongly predictive of risk. Using these factors to predict outcomes in the East Kent cohort yielded an area under the receiver operating characteristic curve (ie, C statistic) of 0.91 (95% CI, 0.87-0.96) for ESRD and 0.82 (95% CI, 0.75-0.89) for death.
Other important factors may have been missed because of limited study power.
Simple laboratory measures of kidney and cardiac function plus age, sex, and smoking history can be used to help identify patients with CKD at highest risk of ESRD and death. Larger cohort studies are required to further validate these results.
需要有效的预测评分来评估慢性肾脏病（CKD）患者终末期肾病（ESRD）和死亡的风险。
前瞻性队列研究，在另一队列中进行验证。
使用 Cox 回归评估 382 例未接受透析治疗的 3-5 期 CKD 患者（CRIB 研究）基线特征与 ESRD（平均随访 4.1 年）和死亡（平均随访 6.0 年）风险的相关性。结果预测方程在另一组 213 例 CKD 患者（东肯特队列）中进行了测试。
44 个基线特征（包括 30 个血液和尿液检测）。
在 CRIB 队列中，190 例患者达到 ESRD（12.1%/y），150 例患者死亡（6.5%/y）。基线估计肾小球滤过率每降低 30%，ESRD 发生率增加 3 倍，死亡率增加 1.3 倍。在相互调整后，只有基线肌酐水平、血清磷酸盐水平、尿白蛋白/肌酐比值和女性性别与 ESRD 仍具有强烈的预测关系（P < 0.01）。对于死亡，年龄、N 末端脑钠肽前体、肌钙蛋白 T 水平和吸烟与风险仍具有强烈的预测关系。使用这些因素预测东肯特队列的结果，ESRD 的受试者工作特征曲线下面积（即 C 统计量）为 0.91（95%CI，0.87-0.96），死亡的为 0.82（95%CI，0.75-0.89）。
由于研究能力有限，可能遗漏了其他重要因素。
简单的肾脏和心脏功能实验室指标，加上年龄、性别和吸烟史，可用于帮助识别 CKD 患者中 ESRD 和死亡风险最高的患者。需要更大的队列研究来进一步验证这些结果。
