Inaguma Daijo, Imai Enyu, Takeuchi Ayano, Ohashi Yasuo, Watanabe Tsuyoshi, Nitta Kosaku, Akizawa Tadao, Matsuo Seiichi, Makino Hirofumi, Hishida Akira
Department of Nephrology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan.
Clin Exp Nephrol. 2017 Jun;21(3):446-456. doi: 10.1007/s10157-016-1309-1. Epub 2016 Jul 13.
Chronic kidney disease (CKD) eventually progresses to end-stage renal disease (ESRD). However, risk factors associated with CKD progression have not been well characterized in Japanese patients with CKD who are less affected with coronary disease than Westerners.
A large-scale, multicenter, prospective, cohort study was conducted in patients with CKD and under nephrology care, who met the eligibility criteria [Japanese; age 20-75 years; and estimated glomerular filtration rate (eGFR): 10-59 mL/min/1.73 m]. The primary endpoint was a composite of time to a 50 % decline in eGFR from baseline or time to the initiation of renal replacement therapy (RRT). The secondary endpoints were the rate of decline in eGFR from baseline, time to a 50 % decline in eGFR from baseline, time to the initiation of RRT, and time to doubling of serum creatinine (Cre) concentration.
2966 patients (female, 38.9 %; age, 60. 3 ± 11.6 years) were enrolled. The incidence of the primary endpoint increased significantly (P < 0.0001) in concert with CKD stage at baseline. The multivariate Cox proportional hazards models revealed that elevated systolic blood pressure (SBP) [hazard ratio (HR) 1.203, 95 % confidence interval (CI) 1.099-1.318)] and increased albumin-to-creatinine ratio (UACR ≥ 1000 mg/g Cre; HR: 4.523; 95 % CI 3.098-6.604) at baseline were significantly associated (P < 0.0001, respectively) with the primary endpoint.
Elevated SBP and increased UACR were risk factors that were significantly associated with CKD progression to ESRD in Japanese patients under nephrology care. UMIN clinical trial registry number: UMIN000020038.
慢性肾脏病（CKD）最终会进展为终末期肾病（ESRD）。然而，在冠心病发病率低于西方人的日本CKD患者中，与CKD进展相关的危险因素尚未得到充分描述。
对符合入选标准（日本人；年龄20 - 75岁；估计肾小球滤过率（eGFR）：10 - 59 mL/min/1.73 m²）并接受肾脏病护理的CKD患者进行了一项大规模、多中心、前瞻性队列研究。主要终点是eGFR从基线下降50%的时间或开始肾脏替代治疗（RRT）的时间的复合终点。次要终点是eGFR从基线的下降率、eGFR从基线下降50%的时间、开始RRT的时间以及血清肌酐（Cre）浓度翻倍的时间。
共纳入2966例患者（女性占38.9%；年龄60.3 ± 11.6岁）。主要终点的发生率与基线时的CKD分期显著相关（P < 0.0001）。多变量Cox比例风险模型显示，基线时收缩压（SBP）升高[风险比（HR）1.203，95%置信区间（CI）1.099 - 1.318]和白蛋白与肌酐比值升高（UACR≥1000 mg/g Cre；HR：4.523；95% CI 3.098 - 6.604）与主要终点显著相关（P均< 0.0001）。
在接受肾脏病护理的日本患者中，SBP升高和UACR升高是与CKD进展至ESRD显著相关的危险因素。UMIN临床试验注册号：UMIN000020038。
