老年心血管疾病患者的慢性肾脏病与预后：CKD-EPI公式与柏林倡议研究-1公式的比较
Chronic kidney disease and prognosis in elderly patients with cardiovascular disease: Comparison between CKD-EPI and Berlin Initiative Study-1 formulas.
作者信息
Tarantini Luigi, McAlister Finlay Aleck, Barbati Giulia, Ezekowitz Justin Adrian, Cioffi Giovanni, Faggiano Pompilio, Pulignano Giovanni, Cherubini Antonella, Grisolia Franceschini Enrico, Di Lenarda Andrea
机构信息
UOC Cardiologia, Azienda ULSS Numero 1, Belluno, Italy.
Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada.
出版信息
Eur J Prev Cardiol. 2016 Sep;23(14):1504-13. doi: 10.1177/2047487316638454. Epub 2016 Mar 17.
BACKGROUND
Chronic kidney disease (CKD) is frequent in patients with cardiovascular (CV) disease and impacts prognosis in these subjects. While current guidelines recommend the CKD-EPI equation for the estimated glomerular filtration rate (eGFR) and recognizing CKD, a new creatinine-based equation - the Berlin Initiative Study-1 (BIS-1) - was generated for elders with a high prevalence of CV disease. We assessed whether BIS-1 provided more accurate risk stratification than the CKD-EPI equation in unselected aged patients with CV disease.
METHODS
Patients aged ≥70 years who were seen consecutively at the Cardiovascular Centre of Trieste (Italy) between November 2009 and October 2013 were recruited into this study. The correlation and agreement between the BIS-1 and CKD-EPI formulas were evaluated and intra-class correlation coefficients (ICCs) were computed in order to estimate the correlation between the two formulas. Patients were followed for all-cause death, composite outcomes of all-cause death/all-cause hospitalization and all-cause death/CV hospitalization.
RESULTS
A total of 7845 subjects met the inclusion criteria for this study. GFR as estimated with the BIS-1 and the CKD-EPI equation was highly correlated (ICC: 0.81; 95% confidence interval [CI]: 0.79-0.82; p < 0.0001). When allocating patients in Kidney Disease Improving Global Outcomes classes of eGFR, compared to CKD-EPI, the BIS-1 formula reclassified 2720 (34.7%) patients: 53 (1.9%) were placed in a better class and 2667 (98.1%) were placed in a worse class. Multivariable Cox models showed that BIS-1 compared to CKD-EPI had a significantly better accuracy for predicting death (NRI: 0.12; 95% CI: 0.03-0.19; p = 0.001), death/CV hospitalization (net reclassification improvement [NRI]: 0.34; 95% CI: 0.27-0.38; p < 0.001) and death/all-cause hospitalization (NRI: 0.14; 95% CI: 0.06-0.21; p = 0.001).
CONCLUSIONS
The BIS-1 formula is better than the CKD-EPI formula for risk stratification of CKD in elderly people with CV disease.
背景
慢性肾脏病（CKD）在心血管（CV）疾病患者中很常见，并影响这些患者的预后。虽然目前的指南推荐使用CKD-EPI方程来估算肾小球滤过率（eGFR）并识别CKD，但针对CV疾病患病率高的老年人，生成了一种新的基于肌酐的方程——柏林倡议研究-1（BIS-1）。我们评估了在未选择的老年CV疾病患者中，BIS-1是否比CKD-EPI方程提供更准确的风险分层。
方法
2009年11月至2013年10月期间在意大利的里雅斯特心血管中心连续就诊的年龄≥70岁的患者被纳入本研究。评估了BIS-1和CKD-EPI公式之间的相关性和一致性，并计算了组内相关系数（ICC），以估计两个公式之间的相关性。对患者进行全因死亡、全因死亡/全因住院和全因死亡/CV住院的复合结局随访。
结果
共有7845名受试者符合本研究的纳入标准。用BIS-1和CKD-EPI方程估算的肾小球滤过率（GFR）高度相关（ICC：0.81；95%置信区间[CI]：0.79-0.82；p<0.0001）。在根据慢性肾脏病全球改善预后组织（KDIGO）的eGFR类别对患者进行分类时，与CKD-EPI相比，BIS-1公式重新分类了2720名（34.7%）患者：53名（1.9%）被分到更好的类别，2667名（98.1%）被分到更差的类别。多变量Cox模型显示，与CKD-EPI相比，BIS-1在预测死亡（净重新分类改善[NRI]：0.12；95%CI：0.03-0.19；p=0.001）、死亡/CV住院（NRI：0.34；95%CI：0.27-0.38；p<0.001）和死亡/全因住院（NRI：0.14；95%CI：0.06-0.21；p=0.001）方面具有显著更好的准确性。
结论
对于患有CV疾病的老年人，BIS-1公式在CKD风险分层方面优于CKD-EPI公式。
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