Nephrology Department, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
Kidney Int. 2012 Dec;82(12):1332-8. doi: 10.1038/ki.2012.281. Epub 2012 Aug 8.
Associations between variability of glomerular filtration rate (GFR), death, and cardiovascular events have not been reported among patients with chronic kidney disease (CKD). In order to evaluate this, we retrospectively analyzed the risk of death and de novo heart failure as a function of variability in estimated GFR among a cohort of 3361 patients with stage 3 CKD. At baseline, patients with greater variability were younger, more likely to have diabetes, hypertension, and other comorbid conditions, and were more likely to have proteinuria and higher estimated GFR. In multivariate-adjusted Cox proportional hazard models over a median follow-up of 3.9 years, the risk of death associated with the highest relative to the lowest quartile of variability was 1.40 (95% confidence interval 1.05-1.87); there was no association with new-onset heart failure. The mortality association was independent of serum albumin, proteinuria, baseline estimated GFR, and the slope of the estimated GFR. Thus, variability in estimated GFR predicts death among patients with stage 3 CKD independent of previously reported risk factors. The prognostic utility of complementing existing risk stratification metrics with dynamic changes in GFR among patients with CKD warrants investigation.
在慢性肾脏病（CKD）患者中，肾小球滤过率（GFR）的变异性与死亡和心血管事件之间的关系尚未报道。为了评估这一点，我们回顾性分析了在 3361 名 3 期 CKD 患者队列中，估计 GFR 变异性与死亡和新发心力衰竭风险之间的关系。在基线时，变异性较大的患者年龄较小，更有可能患有糖尿病、高血压和其他合并症，并且蛋白尿和估计的 GFR 更高。在中位随访 3.9 年的多变量调整 Cox 比例风险模型中，与最低四分位相比，最高四分位的变异性与死亡风险相关的风险比为 1.40（95%置信区间 1.05-1.87）；与新发心力衰竭无关。死亡率的相关性独立于血清白蛋白、蛋白尿、基线估计的 GFR 和估计的 GFR 斜率。因此，在 3 期 CKD 患者中，估计的 GFR 变异性独立于先前报道的风险因素预测死亡。在 CKD 患者中，用 GFR 的动态变化补充现有风险分层指标的预后效用值得进一步研究。
