Kuwahara Michio, Takehara Eriko, Sasaki Yasunori, Azetsu Haruna, Kusaka Keita, Shikuma Satomi, Akita Wataru
Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
Ther Apher Dial. 2016 Feb;20(1):12-9. doi: 10.1111/1744-9987.12332. Epub 2015 Dec 17.
Cardiovascular events (CVEs) are major complications in patients with chronic kidney disease (CKD). However, few studies have investigated the effects of CVEs on end-stage renal disease (ESRD) and mortality of pre-dialysis patients. We followed 377 CKD patients who were at stage ≥G3 at first clinic visit in the Shuuwa General Hospital between April 2005 and July 2014. After taking baseline patient data, we evaluated renal survival rates and all-cause and CVE-related mortality in patients with CVEs [(+)CVEs] and without CVEs [(-)CVEs]. A total of 99 CVEs occurred in 93 study patients (57.0% cardiac events, 43.0% cerebrovascular events, and 6.5% peripheral artery disease events). During the study period, 127 patients reached ESRD over a median of 4.51 years' follow-up. Kaplan-Meier analysis found longer renal survival rates in the (-)CVEs group compared with the (+)CVEs group. Forty patients died during the study period over a median of 5.43 years' follow-up. Survival rates for all-cause and CVE-related mortality of (-)CVEs patients were higher than in (+)CVEs patients. After adjustment for sex, age, current smoking, blood pressure, diabetes, estimated glomerular filtration rate, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, left ventricular hypertrophy, body mass index, albumin, hemoglobin, calcium, phosphate, C-reactive protein, and spot urine protein, the occurrence of CVEs was still a significant risk factor for ESRD (HR 1.516, P = 0.017) and all-cause mortality (HR 7.871, P < 0.001). Our findings suggest that the occurrence of CVEs is a potent risk factor for ESRD and mortality in CKD patients before dialysis.
心血管事件（CVEs）是慢性肾脏病（CKD）患者的主要并发症。然而，很少有研究调查心血管事件对终末期肾病（ESRD）及透析前患者死亡率的影响。我们对2005年4月至2014年7月期间在舒瓦综合医院首诊时处于≥G3期的377例CKD患者进行了随访。在获取患者基线数据后，我们评估了发生心血管事件的患者[（+）CVEs]和未发生心血管事件的患者[（-）CVEs]的肾脏生存率以及全因死亡率和与心血管事件相关的死亡率。93例研究患者共发生99次心血管事件（57.0%为心脏事件，43.0%为脑血管事件，6.5%为外周动脉疾病事件）。在研究期间，127例患者在中位4.51年的随访期内进入ESRD阶段。Kaplan-Meier分析发现，（-）CVEs组的肾脏生存率长于（+）CVEs组。40例患者在中位5.43年的随访期内于研究期间死亡。（-）CVEs患者的全因死亡率和与心血管事件相关的死亡率生存率高于（+）CVEs患者。在对性别、年龄、当前吸烟状况、血压、糖尿病、估计肾小球滤过率、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、左心室肥厚、体重指数、白蛋白、血红蛋白、钙、磷、C反应蛋白和随机尿蛋白进行校正后，心血管事件的发生仍然是ESRD（风险比1.516，P = 0.017）和全因死亡率（风险比7.871，P < 0.001）的显著危险因素。我们的研究结果表明，心血管事件的发生是CKD患者透析前发生ESRD和死亡的有力危险因素。
