Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Clin J Am Soc Nephrol. 2011 Jun;6(6):1385-92. doi: 10.2215/CJN.10271110. Epub 2011 Mar 10.
Whether chronic kidney disease (CKD) should also be considered a coronary disease equivalent like diabetes is not clear.
DESIGN, SETTING, PARTICIPANTS, & METHODS: Veterans with and without diabetes and with and without CKD were prospectively recruited. A competing Cox regression model was used to describe the risk of myocardial infarction (MI) in the two groups (CKD and diabetes) over a decade of follow-up.
The incidence rate of MI in those without CKD was 0.047/yr and in those with CKD was 0.206/yr. Multivariate adjustment revealed the incident rate ratio for MI in CKD as 3.5 and for diabetes mellitus as 2.5. The cumulative incidence for MI was influenced by CKD and diabetes. CKD was associated with a subhazard ratio for MI of 3.74; in contrast, diabetes was associated with a subhazard ratio for MI of 2.6. For the outcome of all-cause mortality, after multivariate adjustment, CKD was associated with a hazard ratio (HR) of 1.86, which was similar to the HR of 2.27 for prevalent coronary artery disease. The HR for diabetes was NS at 1.35.
CKD is associated with a risk of death similar to that of established coronary artery disease and higher than that of diabetes mellitus. CKD is associated with a risk of MI that is at least as much as that from diabetes mellitus. Among veterans, CKD appears to be a coronary disease equivalent.
慢性肾脏病（CKD）是否也应被视为与糖尿病等同的冠心病，目前尚不清楚。
设计、设置、参与者和方法：前瞻性招募了有和没有糖尿病以及有和没有 CKD 的退伍军人。使用竞争 Cox 回归模型描述了两组（CKD 和糖尿病）在十年随访期间发生心肌梗死（MI）的风险。
无 CKD 患者的 MI 发生率为 0.047/年，而有 CKD 患者的 MI 发生率为 0.206/年。多变量调整显示，CKD 患者发生 MI 的发生率比为 3.5，糖尿病患者为 2.5。MI 的累积发生率受 CKD 和糖尿病的影响。CKD 与 MI 的亚危险比相关，为 3.74；相比之下，糖尿病与 MI 的亚危险比相关，为 2.6。对于全因死亡率的结局，经多变量调整后，CKD 与 HR 为 1.86，与已确诊的冠心病的 HR（2.27）相似。糖尿病的 HR 无统计学意义（NS）为 1.35。
CKD 与死亡风险相关，与已确诊的冠心病相似，高于糖尿病。CKD 与 MI 的风险相关，至少与糖尿病相当。在退伍军人中，CKD 似乎是一种冠心病的等同物。
