肾功能的一年变化与死亡率升高相关。
One-year change in kidney function is associated with an increased mortality risk.
机构信息
Department of Medicine, University of Calgary, AB, Canada.
出版信息
Am J Nephrol. 2012;36(1):41-9. doi: 10.1159/000339289. Epub 2012 Jun 14.
BACKGROUND
Serum creatinine is routinely measured to estimate glomerular filtration rate (GFR). Long-term cohort studies report that death is a likelier outcome than progression to kidney failure. However, it is unclear how short-term changes in estimated GFR (eGFR) over a 1-year period relate to subsequent mortality risk.
METHODS
Using a provincial laboratory registry from Alberta, Canada, we identified 598,397 adults who had ≥2 outpatient eGFR measurements at least 6 months apart during a 1-year accrual period. Change in kidney function was categorized by both changes in eGFR category and percent change ≥25% into 5 groups: certain drop, uncertain drop, stable (no change in CKD category), uncertain rise, and certain rise. Cox proportional hazards models, adjusting for baseline covariates, kidney function, and proteinuria were used to estimate the risk of all-cause mortality associated with each group change in kidney function in reference to stable kidney function.
RESULTS
Among the study participants, 447,570 (74.8%) had stable kidney function, 19,591 (3.3%) had a certain drop, and 22,171 (3.7%) had a certain rise in kidney function. Participants with change in kidney function (both drop and rise) were older, more likely to be female, and had a higher prevalence of comorbidities in comparison to those with stable kidney function. There were 51,473 (8.6%) deaths during a median follow-up of 3.5 years. Compared to participants with stable kidney function, those with a certain drop had an almost twofold increased mortality risk (hazard ratio 1.89, 95% CI 1.83-1.95) adjusted for baseline eGFR, proteinuria, and covariates. Participants with a certain rise (3.7%) in kidney function also experienced an increased mortality risk (hazard ratio 1.51, 95% CI 1.46-1.56) compared to those with stable kidney function. Risk of death was similarly increased with adjustment for eGFR at the last visit.
CONCLUSION
Change in kidney function of ≥25% in any direction over a 1-year period is associated with a substantially increased risk of mortality.
背景
血清肌酐的常规检测用于估计肾小球滤过率（GFR）。长期队列研究报告，死亡是比进展为肾衰竭更有可能的结果。然而，尚不清楚在 1 年内估计 GFR（eGFR）的短期变化与随后的死亡风险有何关系。
方法
利用加拿大艾伯塔省的一个省级实验室登记处，我们确定了 598397 名成年人，他们在 1 年的累积期内至少有 2 次相隔至少 6 个月的门诊 eGFR 测量。肾功能变化分为 eGFR 类别变化和≥25%的百分比变化两个类别，分为 5 组：确定下降、不确定下降、稳定（CKD 类别无变化）、不确定上升和确定上升。使用 Cox 比例风险模型，根据基线协变量、肾功能和蛋白尿进行调整，以估计与稳定肾功能相比，肾功能变化各组与全因死亡率相关的风险。
结果
在研究参与者中，447570 人（74.8%）的肾功能稳定，19591 人（3.3%）的肾功能确定下降，22171 人（3.7%）的肾功能确定上升。与肾功能稳定的参与者相比，肾功能变化（下降和上升）的参与者年龄更大，更可能为女性，且合并症的患病率更高。在中位随访 3.5 年期间，有 51473 人（8.6%）死亡。与肾功能稳定的参与者相比，肾功能确定下降的参与者死亡风险几乎增加了两倍（风险比 1.89，95%CI 1.83-1.95），经基线 eGFR、蛋白尿和协变量调整后。肾功能确定上升（3.7%）的参与者与肾功能稳定的参与者相比，死亡率也有所增加（风险比 1.51，95%CI 1.46-1.56）。经最后一次就诊时 eGFR 调整后，死亡风险也同样增加。
结论
在 1 年内，任何方向的肾功能变化≥25%与死亡率显著增加相关。
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