Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA.
Am J Respir Crit Care Med. 2011 Nov 15;184(10):1147-52. doi: 10.1164/rccm.201105-0932OC. Epub 2011 Jul 28.
Adults with cystic fibrosis (CF) possess multiple potential risk factors for chronic kidney disease, including CF-related diabetes (CFRD) and lifetime nephrotoxic drug exposure.
To determine whether cumulative intravenous (IV) aminoglycoside exposure and CFRD increase the risk of chronic kidney disease in adults with CF.
This was a cohort study using adults (≥ 18 yr) in the CF Foundation registry from 2001-2008. Chronic kidney disease (stage 3 or greater) was defined by an estimated glomerular filtration rate of less than 60 ml/min/1.73 m(2). Time-dependent multivariable Cox proportional hazards models were used to determine whether cumulative number of acute pulmonary exacerbations (surrogate for IV aminoglycoside exposure) and CFRD requiring insulin increase the risk of chronic kidney disease, adjusting for confounders.
The study cohort included 11,912 adults with a median follow-up of 4 years. During the study period, 204 subjects had chronic kidney disease, with an annual disease prevalence of 2.3%. Disease prevalence doubled with every 10-year increase in age. CFRD requiring insulin therapy substantially increased the risk of chronic kidney disease (1-4 yr of CFRD requiring insulin vs. no CFRD, hazard ratio [HR] = 2.40, 95% confidence interval [CI] 1.74-3.32; ≥ 5 yr, HR = 4.56, 95% CI 2.84-7.31). Pulmonary exacerbations did not significantly increase the risk of chronic kidney disease (one to five exacerbations vs. none, HR = 0.79, 95% CI 0.56-1.11; six to nine exacerbations, HR = 0.92, 95% CI 0.58-1.46; ≥ 10 exacerbations, HR = 1.16, 95% CI 0.75-1.81).
CF-related diabetes is a significant risk factor for chronic kidney disease in adults with CF, but additional studies examining IV aminoglycoside exposure directly are required.
患有囊性纤维化（CF）的成年人存在多种慢性肾脏病的潜在风险因素，包括 CF 相关糖尿病（CFRD）和终生肾毒性药物暴露。
确定静脉内（IV）氨基糖苷类药物暴露和 CFRD 是否会增加 CF 成人慢性肾脏病的风险。
这是一项使用 2001-2008 年 CF 基金会登记处的成年人（≥18 岁）的队列研究。慢性肾脏病（3 期或更高级别）的定义为肾小球滤过率估计值<60ml/min/1.73m²。采用时间依赖性多变量 Cox 比例风险模型来确定累积急性肺部加重次数（IV 氨基糖苷类药物暴露的替代指标）和需要胰岛素治疗的 CFRD 是否会增加慢性肾脏病的风险，同时调整混杂因素。
该研究队列包括 11912 名成年人，中位随访时间为 4 年。在研究期间，有 204 名患者患有慢性肾脏病，年患病率为 2.3%。每增加 10 岁，疾病患病率就会增加一倍。需要胰岛素治疗的 CFRD 显著增加慢性肾脏病的风险（1-4 年 CFRD 需要胰岛素治疗与无 CFRD 相比，风险比[HR] = 2.40，95%置信区间[CI]1.74-3.32；≥5 年，HR = 4.56，95% CI 2.84-7.31）。肺部加重并没有显著增加慢性肾脏病的风险（1-5 次肺部加重与无肺部加重相比，HR = 0.79，95% CI 0.56-1.11；6-9 次肺部加重，HR = 0.92，95% CI 0.58-1.46；≥10 次肺部加重，HR = 1.16，95% CI 0.75-1.81）。
CF 相关糖尿病是 CF 成人慢性肾脏病的一个重要危险因素，但需要进一步研究直接评估 IV 氨基糖苷类药物暴露的影响。
