Couderc Marion, Tatar Zuzana, Pereira Bruno, Tiple Aurélien, Gilson Mélanie, Fautrel Bruno, Pouplin Sophie, Dernis Emmanuelle, Gossec Laure, Gaujoux-Viala Cécile, Soubrier Martin, Dougados Maxime
Gabriel Montpied University Hospital, Clermont-Ferrand, France.
Sud University Hospital, Grenoble, France.
Arthritis Care Res (Hoboken). 2016 May;68(5):638-44. doi: 10.1002/acr.22713.
To assess the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA).
COMEDRA is a French nationwide cross-sectional multicenter study on comorbidities in RA. Renal function was assessed from the estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease equation. RA characteristics and risk factors for renal impairment were collected. Two logistic regression models, 1 with and 1 without the Framingham Risk Score, were constructed from variables that were significantly associated with an eGFR of <60 ml/minute/1.73 m(2) or were clinically relevant.
Of the 970 recruited patients, 931 were analyzed (women 79.6%, mean age 57.8 years, disease duration 11.1 years, Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR] 3.1). A total of 82 patients (8.8%) had an eGFR <60 ml/minute/1.73 m(2) and 9% had proteinuria. In univariate analysis, renal impairment was associated with age (P < 0.001), history of hypertension (P < 0.001), high systolic blood pressure (P = 0.03), and the Systematic Coronary Risk Evaluation (SCORE) equation (P = 0.002), but not with sex, disease duration, disease activity (as assessed by DAS28-ESR), nonsteroidal antiinflammatory drug use, disease severity (erosions, joint replacement), or RA medications. Multivariate analysis models showed that age (odds ratio [OR] 1.05 [95% confidence interval (95% CI) 1.03-1.09]) and hypertension (OR 2.5 [95% CI 1.5-4.3]) were associated with renal impairment. A second model showed that the SCORE equation (OR 1.33 [95% CI 1.06-1.67]) was associated with renal impairment.
Renal impairment is relatively common in RA and is associated with cardiovascular risk factors such as age, hypertension, and the SCORE equation but not with disease activity or severity.
评估类风湿关节炎（RA）患者肾功能不全的患病率及其相关因素。
COMEDRA是一项关于RA合并症的法国全国性横断面多中心研究。使用肾脏病饮食改良公式根据估算的肾小球滤过率（eGFR）评估肾功能。收集RA的特征和肾功能损害的危险因素。根据与eGFR<60 ml/分钟/1.73 m²显著相关或具有临床相关性的变量构建两个逻辑回归模型，一个包含弗雷明汉风险评分，另一个不包含。
在970名招募的患者中，对931名进行了分析（女性占79.6%，平均年龄57.8岁，病程11.1年，使用红细胞沉降率的28个关节疾病活动评分[DAS28-ESR]为3.1）。共有82名患者（8.8%）的eGFR<60 ml/分钟/1.73 m²，9%的患者有蛋白尿。在单因素分析中，肾功能损害与年龄（P<0.001）、高血压病史（P<0.001）、高收缩压（P = 0.03）和系统性冠状动脉风险评估（SCORE）公式（P = 0.002）相关，但与性别、病程、疾病活动度（通过DAS28-ESR评估）、非甾体抗炎药使用、疾病严重程度（侵蚀、关节置换）或RA药物无关。多因素分析模型显示，年龄（比值比[OR]1.05[95%置信区间（95%CI）1.03 - 1.09]）和高血压（OR 2.5[95%CI 1.5 - 4.3]）与肾功能损害相关。第二个模型显示，SCORE公式（OR 1.33[95%CI 1.06 - 1.67]）与肾功能损害相关。
肾功能损害在RA中相对常见，且与年龄、高血压和SCORE公式等心血管危险因素相关，但与疾病活动度或严重程度无关。
