Januszko-Giergielewicz Beata, Kubiak Monika, Bednarski Krzysztof, Piotrkowski Jakub, Giergielewiczi Katarzyna, Smyk Łukasz, Romaszko Jerzy, Gromadziński Leszek
Przegl Lek. 2015;72(2):64-70.
The introduction of the classification of chronic kidney disease (CKD) by NKF KDOQI guidelines in 2002, including the staging and risk assessment of this disease, was a landmark event. The division of CKD into stages 1-5 turned out to be very useful and sensitive tool in the hands of both scientists and clinical practitioners; it established common nomenclature pertaining to CKD all over the world. This stratification profoundly changed the approach to CKD, transforming it from a somewhat neglected clinical problem to the phenomenon named "the epidemic of CKD". However, after a short period if clinical experience a heated debate was initiated in the literature, indicating the shortcomings of the adopted classification. The most questionable areas included methodological issues as well as dissimilar prognoses for patients depending on the cause of kidney dysfunction, the presence of proteinuria and comorbidities.
The aim of this study was to evaluate the prevalence of CKD and the risk factors based on NKF KDOQI classification of 2002 in the population of Ostróda administrative district.
In total 437 individuals (F 277, M 160) aged 52.7±18.0 were examined. The study was conducted in Ostróda among randomly selected inhabitants of Ostróda adminstrative district. Serum creatinine was determined by a modified Jaffe method and eGFR was calculated (MDRD formula) for each individual. The correlations between serum creatinine and eGFR, gender and age were studied. Additionally, 326 of the examined participants were interviewed to establish CKD risk factors: kidney disease in the family, being overweight and/or obese, arterial hypertension, diabetes, smoking, heart attack, stroke.
58.6% of the examined individuals demonstrated abnormal eGFR values (<90 ml/min/l.73 m2), whereas serum creatinine above the laboratory norm was found in 1.3% of patients. Significant CKD risk factors included an increased prevalence of obesity (78.3%), arterial hypertension (38.6%), and smoking (26.8%); 23.9% reported kidney disease in the family.
Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice.
2002年美国国家肾脏基金会（NKF）发布的《肾脏病生存质量指南》（KDOQI）引入了慢性肾脏病（CKD）的分类，包括该疾病的分期和风险评估，这是一个具有里程碑意义的事件。CKD分为1 - 5期，这一分类在科学家和临床医生手中被证明是非常有用且敏感的工具；它确立了全球范围内与CKD相关的通用术语。这种分层深刻改变了对CKD的处理方式，将其从一个有些被忽视的临床问题转变为被称为“CKD流行”的现象。然而，经过短暂的临床实践后，文献中引发了激烈的争论，指出了所采用分类的缺点。最值得质疑的领域包括方法学问题，以及根据肾功能不全的病因、蛋白尿的存在和合并症对患者的不同预后。
本研究的目的是根据2002年NKF KDOQI分类评估奥斯特罗达行政区人群中CKD的患病率及其危险因素。
总共检查了437名年龄为52.7±18.0岁的个体（女性277名，男性160名）。该研究在奥斯特罗达行政区随机选择的居民中进行。采用改良的Jaffe法测定血清肌酐，并为每个个体计算估算肾小球滤过率（eGFR）（MDRD公式）。研究了血清肌酐与eGFR、性别和年龄之间的相关性。此外，对326名受检参与者进行了访谈，以确定CKD的危险因素：家族性肾病、超重和/或肥胖、动脉高血压、糖尿病、吸烟、心脏病发作、中风。
58.6%的受检个体eGFR值异常（<90 ml/min/1.73 m²），而1.3%的患者血清肌酐高于实验室正常范围。显著的CKD危险因素包括肥胖患病率增加（78.3%）、动脉高血压（38.6%）和吸烟（26.8%）；23.9%的人报告有家族性肾病。
基于我们的研究，可以得出结论，根据2002年分类评估的CKD患病率似乎被高估了，导致CKD误诊的主要因素是eGFR值随年龄增长而出现的生理性下降。NKF在2012年对CKD分类所做的修改需要在日常临床实践中进一步观察和评估其有用性。
