Kim Hyoungnae, Yoo Tae Hyun, Choi Kyu Hun, Oh Kook Hwan, Lee Joongyub, Kim Soo Wan, Kim Tae Hee, Sung Suah, Han Seung Hyeok
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University, Seoul, Korea.
J Korean Med Sci. 2017 Feb;32(2):231-239. doi: 10.3346/jkms.2017.32.2.231.
Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). We report the baseline cardiovascular characteristics of 2,238 participants by using the data of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) study. The cohort comprises 5 subcohorts according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), polycystic kidney disease (PKD), and unclassified. The average estimated glomerular filtration rate (eGFR) was 50.5 ± 30.3 mL/min⁻¹/1.73 m⁻² and lowest in the DN subcohort. The overall prevalence of previous CVD was 14.4% in all patients, and was highest in the DN followed by that in the HTN subcohort. The DN subcohort had more adverse cardiovascular risk profiles (higher systolic blood pressure [SBP], and higher levels of cardiac troponin T, left ventricular mass index [LVMI], coronary calcium score, and brachial-ankle pulse wave velocity [baPWV]) than the other subcohorts. The HTN subcohort exhibited less severe cardiovascular risk profiles than the DN subcohort, but had more severe cardiovascular risk features than the GN and PKD subcohorts. All these cardiovascular risk profiles were inversely correlated with eGFR. In conclusion, this study shows that the KNOW-CKD cohort exhibits high cardiovascular burden, as other CKD cohorts in previous studies. Among the subcohorts, the DN subcohort had the highest risk for CVD. The ongoing long-term follow-up study up to 10 years will further delineate cardiovascular characteristics and outcomes of each subcohort exposed to different risk profiles.
心血管疾病(CVD)是慢性肾脏病(CKD)患者最常见的死亡原因。我们利用韩国慢性肾脏病患者结局队列研究(KNOW-CKD)的数据报告了2238名参与者的基线心血管特征。该队列根据CKD的病因分为5个子队列:肾小球肾炎(GN)、糖尿病肾病(DN)、高血压肾病(HTN)、多囊肾病(PKD)和未分类。平均估计肾小球滤过率(eGFR)为50.5±30.3 mL/min⁻¹/1.73 m⁻²,在DN子队列中最低。所有患者既往CVD的总体患病率为14.4%,在DN中最高,其次是HTN子队列。与其他子队列相比,DN子队列具有更多不良心血管风险特征(收缩压[SBP]更高,心肌肌钙蛋白T、左心室质量指数[LVMI]、冠状动脉钙化评分和臂踝脉搏波速度[baPWV]水平更高)。HTN子队列的心血管风险特征不如DN子队列严重,但比GN和PKD子队列具有更严重的心血管风险特征。所有这些心血管风险特征均与eGFR呈负相关。总之,本研究表明,与既往研究中的其他CKD队列一样,KNOW-CKD队列呈现出较高的心血管负担。在各子队列中,DN子队列的CVD风险最高。正在进行的长达10年的长期随访研究将进一步描绘每个暴露于不同风险特征的子队列的心血管特征和结局。