Henry Hood Center for Health Research, MC-44-00, 100 North Academy Avenue, Danville, PA 17822, USA.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1879-86. doi: 10.2215/CJN.00470111. Epub 2011 Jun 16.
Estimates of the effect of estimated GFR (eGFR) decline on mortality have focused on populations with normal kidney function, or have included limited information on factors previously shown to influence the risk of death among patients with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively assessed the effect of rate of eGFR decline on survival of patients with CKD receiving primary care through a large integrated health care system in central Pennsylvania between January 1, 2004, and December 31, 2009.
A total of 15,465 patients were followed for a median of 3.4 years. Median rates of eGFR change by those in the lower, middle, and upper tertiles of eGFR slope were -4.8, -0.6, and 3.5 ml/min per 1.73 m(2)/yr, respectively. In Cox proportional hazard modeling for time to death, adjusted for baseline proteinuria, changes in nutritional parameters, and episodes of acute kidney injury during follow-up (among other covariates), the hazard ratio for those in the lower (declining) and upper (increasing) eGFR tertiles (relative to the middle, or stable, tertile) was 1.84 and 1.42, respectively. Longitudinal changes in nutritional status as well as episodes of acute kidney injury attenuated the risk only modestly. These findings were consistent across subgroups.
eGFR change over time adds prognostic information to traditional mortality risk predictors among patients with CKD. The utility of incorporating eGFR trends into patient-risk assessment should be further investigated.
估计肾小球滤过率（eGFR）下降对死亡率的影响，主要集中在肾功能正常的人群，或仅包括先前已显示会影响 CKD 患者死亡风险的有限信息。
设计、设置、参与者和测量：我们通过宾夕法尼亚州中部的一个大型综合医疗保健系统，对 2004 年 1 月 1 日至 2009 年 12 月 31 日期间接受初级保健的 CKD 患者的 eGFR 下降速度对生存率的影响进行了回顾性评估。
共 15465 例患者接受了中位数为 3.4 年的随访。eGFR 斜率较低、中、高三分位组的 eGFR 变化中位数分别为-4.8、-0.6 和 3.5 ml/min/1.73m(2)/yr。在 Cox 比例风险模型中，对死亡时间进行了调整，以适应基线蛋白尿、营养参数变化和随访期间急性肾损伤发作（除其他协变量外），eGFR 较低（下降）和较高（升高）三分位组的危险比（相对于中间或稳定三分位组）分别为 1.84 和 1.42。营养状况的纵向变化和急性肾损伤发作仅适度减弱了风险。这些发现在各亚组中均一致。
随着时间的推移，eGFR 的变化为 CKD 患者的传统死亡率风险预测指标增加了预后信息。将 eGFR 趋势纳入患者风险评估中的效用应进一步研究。
