Inaguma Daijo, Murata Minako, Tanaka Akihito, Shinjo Hibiki
Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Clin Exp Nephrol. 2017 Feb;21(1):159-168. doi: 10.1007/s10157-016-1262-z. Epub 2016 Apr 15.
The timing for initiating dialysis in chronic kidney disease is often determined by the clinical symptoms and estimated glomerular filtration rate (eGFR). However, very few studies have examined how the speed of kidney function decline before initiating dialysis relates to mortality after dialysis initiation. Here, we report our examination of the relationship between the speed of eGFR decline in the 3 months prior to dialysis initiation and mortality.
The study included 1292 new dialysis patients who were registered in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. The subjects were placed in 4 groups based on the speed of eGFR decline in the 3 months before initiating dialysis (eGFR at 3 months before initiation-eGFR at initiation) <2: ≥2, <4: ≥4, <6: ≥6 mL/min/1.73 m. All-cause, cardiovascular, and infection-related mortality rates were compared using Kaplan-Meier curves. A multivariate analysis using the Cox proportional hazard model was used to extract the factors that contributed to all-cause mortality.
The group with faster eGFR decline exhibited significantly more heart failure symptoms when dialysis was initiated. Rapid eGFR decline correlated with prognosis (log-rank test: all-cause mortality p < 0.001, cardiovascular mortality p < 0.001). The speed of eGFR decline was related to elevated all-cause mortality rates [eGFR decline 10 mL/min/1.73 m, HR (95 % CI) = 1.53 (1.12-2.08)].
This study showed that patients with rapid eGFR decline in the 3 months before initiating dialysis more often presented with heart failure symptoms when dialysis was initiated and had poorer survival prognoses.
慢性肾脏病开始透析的时机通常由临床症状和估计肾小球滤过率（eGFR）决定。然而，很少有研究探讨开始透析前肾功能下降速度与开始透析后的死亡率之间的关系。在此，我们报告我们对开始透析前3个月eGFR下降速度与死亡率之间关系的研究。
该研究纳入了1292名新开始透析的患者，这些患者登记于爱知县新开始透析患者预后队列研究。根据开始透析前3个月eGFR下降速度（开始透析前3个月的eGFR - 开始透析时的eGFR）将受试者分为4组：<2：≥2，<4：≥4，<6：≥6 mL/min/1.73m²。使用Kaplan-Meier曲线比较全因、心血管和感染相关死亡率。使用Cox比例风险模型进行多变量分析，以提取导致全因死亡率的因素。
eGFR下降速度较快的组在开始透析时出现心力衰竭症状的情况明显更多。eGFR快速下降与预后相关（对数秩检验：全因死亡率p < 0.001，心血管死亡率p < 0.001）。eGFR下降速度与全因死亡率升高有关[eGFR下降10 mL/min/1.73m²，HR（95%CI）= 1.53（1.12 - 2.08）]。
本研究表明，开始透析前3个月eGFR快速下降的患者在开始透析时更常出现心力衰竭症状，且生存预后较差。
