Maeda Kunimi, Hamada Chieko, Horikoshi Satoshi, Tomino Yasuhiko
Division of Nephrology, Department of Internal Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
ISRN Nephrol. 2012 Nov 26;2013:351364. doi: 10.5402/2013/351364. eCollection 2013.
Purpose. To explore factors contributing to chronic kidney disease (CKD) progression and change in estimated glomerular filtration rate over time (ΔeGFR) as a risk factor in predialysis patients under multidisciplinary managements. Methods. Among 113 CKD patients, eGFR, serum creatinine, total protein, albumin, urea nitrogen, uric acid, calcium, inorganic phosphate, total cholesterol, urinary creatinine, urinary protein (UP), hemoglobin A1c, hemoglobin, and hematocrit were analyzed. Results. ΔeGFR analysis in the first six months presented a positive slope (remission group) in 43 patients (38%) and a negative slope (no-remission group) in 70 patients (62%). Three-year dialysis-free rate was 89.4% in the remission group and 39.3% in the no-remission group, with a significant difference (P < 0.0001). To explore factors contributing to dialysis initiation by stepwise Cox regression, baseline eGFR (HR 0.706, P < 0.0001) and ΔeGFR in the first six months of treatment (HR 0.075, P < 0.0001) were identified. To investigate factors affecting remission and no remission by stepwise logistic regression, age (odds ratio 1.06, P = 0.018) and UP excretion (odds ratio 1.223, P = 0.045) were identified. Conclusion. Monitoring of ΔeGFR and UP is not only useful in suppressing CKD 3 progression, but also in deciding strategies to achieve remission in individual patients.
目的。探讨在多学科管理下，导致慢性肾脏病（CKD）进展以及估算肾小球滤过率随时间变化（ΔeGFR）作为透析前患者危险因素的相关因素。方法。对113例CKD患者的估算肾小球滤过率、血清肌酐、总蛋白、白蛋白、尿素氮、尿酸、钙、无机磷、总胆固醇、尿肌酐、尿蛋白（UP）、糖化血红蛋白、血红蛋白和血细胞比容进行分析。结果。前六个月的ΔeGFR分析显示，43例患者（38%）呈正斜率（缓解组），70例患者（62%）呈负斜率（未缓解组）。缓解组的三年未透析率为89.4%，未缓解组为39.3%，差异有统计学意义（P < 0.0001）。通过逐步Cox回归探索导致开始透析的因素，确定了基线估算肾小球滤过率（HR 0.706，P < 0.0001）和治疗前六个月的ΔeGFR（HR 0.075，P < 0.0001）。通过逐步逻辑回归研究影响缓解和未缓解的因素，确定了年龄（比值比1.06，P = 0.018）和UP排泄量（比值比1.223，P = 0.045）。结论。监测ΔeGFR和UP不仅有助于抑制CKD 3期进展，还有助于确定个体患者实现缓解的策略。
