Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Am J Kidney Dis. 2011 Dec;58(6):886-93. doi: 10.1053/j.ajkd.2011.07.018. Epub 2011 Sep 22.
Identification of persons with chronic kidney disease (CKD) who are at highest risk to progress to end-stage renal disease (ESRD) is necessary to reduce the burden of kidney failure. The relative utility of traditional markers of kidney function, including estimated glomerular filtration rate (eGFR) and serum creatinine level, and emerging markers of kidney function, including cystatin C and beta-trace protein (BTP) levels, to predict ESRD and mortality has yet to be established.
Randomized clinical trial followed by an observational cohort study.
SETTING & PARTICIPANTS: 865 African American individuals with hypertensive CKD enrolled in a clinical trial of 2 levels of blood pressure control and 3 different antihypertensive drugs as initial therapy and subsequently followed by an observational cohort study.
Quintile of measured GFR (mGFR) by iothalamate clearance, serum creatinine, serum creatinine-based eGFR, cystatin C, and BTP values.
OUTCOMES & MEASUREMENTS: Incidence of ESRD and mortality.
246 participants reached ESRD during a median follow-up of 102 months. The incidence rate of ESRD was higher with higher quintiles of each marker. The association between higher BTP level and ESRD was stronger than those for the other markers, including mGFR. All markers remained significantly associated with ESRD after adjustment for mGFR and relevant covariates (all P < 0.05), with BTP level retaining the strongest association (HR for highest vs lowest quintile, 5.7; 95% CI, 2.2-14.9). Associations with the combined end point of ESRD or mortality (n = 390) were weaker, but remained significant for cystatin C (P = 0.05) and BTP levels (P = 0.004).
The ability of these markers to predict ESRD and mortality in other racial and ethnic groups and in individuals with CKD due to other causes is unknown.
Plasma BTP and cystatin C levels may be useful adjuncts to serum creatinine level and mGFR in evaluating risk of progression of kidney disease.
识别慢性肾脏病（CKD）患者中最有可能进展为终末期肾病（ESRD）的人群，对于降低肾衰竭负担是必要的。传统的肾功能标志物，包括估算肾小球滤过率（eGFR）和血清肌酐水平，以及新兴的肾功能标志物，包括胱抑素 C 和β-微量蛋白（BTP）水平，对预测 ESRD 和死亡率的相对效用尚未确定。
随机临床试验，随后进行观察性队列研究。
865 名非裔美国高血压 CKD 患者参加了一项临床试验，该试验评估了 2 种血压控制水平和 3 种不同的降压药物作为初始治疗，随后进行了一项观察性队列研究。
碘酞酸盐清除率、血清肌酐、基于血清肌酐的 eGFR、胱抑素 C 和 BTP 值的五分位数测量肾小球滤过率（mGFR）。
246 名参与者在中位随访 102 个月时达到 ESRD。每个标志物的五分位数越高，ESRD 的发生率越高。与其他标志物相比，BTP 水平与 ESRD 的相关性更强，包括 mGFR。在调整 mGFR 和相关协变量后，所有标志物与 ESRD 仍有显著相关性（所有 P<0.05），BTP 水平保持最强相关性（最高五分位数与最低五分位数相比的 HR，5.7；95%CI，2.2-14.9）。与 ESRD 或死亡率的联合终点（n=390）的相关性较弱，但胱抑素 C（P=0.05）和 BTP 水平仍有显著相关性（P=0.004）。
这些标志物在其他种族和族裔群体以及由其他原因引起的 CKD 患者中预测 ESRD 和死亡率的能力尚不清楚。
血浆 BTP 和胱抑素 C 水平可能有助于评估肾脏疾病进展的风险，可作为血清肌酐水平和 mGFR 的补充。
