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慢性肾脏病进展至终末期肾病:关于潜在肾脏疾病作用的单中心经验

Chronic kidney disease progression to end stage renal disease: a single center experience of the role of the underlying kidney disease.

作者信息

Ekart Robert, Ferjuc Anita, Furman Barbara, Gerjevič Špela, Bevc Sebastjan, Hojs Radovan

机构信息

Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia.

出版信息

Ther Apher Dial. 2013 Aug;17(4):363-7. doi: 10.1111/1744-9987.12079.

Abstract

Chronic kidney disease (CKD) is common and several factors affect its progression to end-stage renal disease (ESRD). The main goal of our study was to assess the influence of underlying kidney disease and some other important factors during the time of CKD progression to ESRD. A retrospective study of 91 patients (57 men, 34 women; average age 57.7 ± 13.2 years) was carried out. Patients were monitored at least one month before the first renal replacement treatment (RRT). Estimated glomerular filtration rate (eGFR) at first referral to nephrologist was determined by Modification of Diet in Renal Disease equation. Proteinuria was assessed semiquantitatively with dipsticks. Thirty-five patients (38.5%) had diabetic nephropathy (DN), 21 (23.1%) hypertensive nephrosclerosis (HN), 21 (23.1%) adult polycystic kidney disease (APKD) and 14 (15.4%) immunoglobulin A nephropathy (IgAN). Average eGFR at first referral for DN patients was 20.1, and then 23.4 for HN, 35.5 for APKD, and 36.4 mL/min per 1,73 m(2) for IgAN patients. Average time between first nephrological visit and first RRT was 28.4 months for DN patients, 41 for HN, 80.8 for APKD, and 70.1 for IgAN patients. Comparison of all four groups of CKD patients showed that in patients with APKD and IgAN impairment of kidney function to ESRD had progressed statistically significantly slower (P < 0.001). When eGFR at referral, proteinuria, smoking, and renin-angiontensin-aldosterone blockade treatment had been added into the model, patients with APKD and IgAN had a statistically significant longer period between first nephrological visit and first RRT (P < 0.026). In comparison with patients with other underlying causes of CKD, patients with APKD and IgAN had a statistically significant slower progression rate of CKD to ESRD.

摘要

慢性肾脏病(CKD)很常见,有多种因素会影响其进展至终末期肾病(ESRD)。我们研究的主要目的是评估基础肾脏疾病及其他一些重要因素在CKD进展至ESRD期间的影响。对91例患者(57例男性,34例女性;平均年龄57.7±13.2岁)进行了一项回顾性研究。在首次肾脏替代治疗(RRT)前至少1个月对患者进行监测。首次转诊至肾病科时的估算肾小球滤过率(eGFR)通过肾脏病饮食改良方程确定。蛋白尿用试纸进行半定量评估。35例患者(38.5%)患有糖尿病肾病(DN),21例(23.1%)患有高血压性肾硬化(HN),21例(23.1%)患有成人多囊肾病(APKD),14例(15.4%)患有免疫球蛋白A肾病(IgAN)。DN患者首次转诊时的平均eGFR为20.1,HN患者为23.4,APKD患者为35.5,IgAN患者为36.4 mL/min/1.73 m²。DN患者从首次肾病就诊到首次RRT的平均时间为28.4个月,HN患者为41个月,APKD患者为80.8个月,IgAN患者为70.1个月。对所有四组CKD患者的比较显示,APKD和IgAN患者的肾功能损害进展至ESRD在统计学上明显较慢(P<0.001)。当将转诊时的eGFR、蛋白尿、吸烟和肾素 - 血管紧张素 - 醛固酮阻断治疗纳入模型时,APKD和IgAN患者从首次肾病就诊到首次RRT的时间在统计学上明显更长(P<0.026)。与其他CKD基础病因的患者相比,APKD和IgAN患者的CKD进展至ESRD的速率在统计学上明显较慢。

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