透析开始时血尿素氮与血清肌酐的比值与死亡率相关：一项多中心前瞻性队列研究。

Ratio of blood urea nitrogen to serum creatinine at initiation of dialysis is associated with mortality: a multicenter prospective cohort study.

作者信息

Inaguma Daijo, Koide Shigehisa, Ito Eri, Takahashi Kazuo, Hayashi Hiroki, Hasegawa Midori, Yuzawa Yukio

机构信息

Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.

The Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP) Group, Toyoake, Japan.

出版信息

Clin Exp Nephrol. 2018 Apr;22(2):353-364. doi: 10.1007/s10157-017-1458-x. Epub 2017 Aug 1.

DOI:10.1007/s10157-017-1458-x

PMID:28766029

Abstract

BACKGROUND

Some studies have shown that the estimated glomerular filtration rate (eGFR) at the time of initiating dialysis was associated with mortality. However, the relationship between ratio of blood urea nitrogen to serum creatinine (BUN/Cr) and mortality is unknown.

METHODS

The study was a multicenter, prospective cohort analysis including 1520 patients. Patients were classified into four quartiles based on the BUN/Cr ratio at the dialysis initiation, with Q1 having the lowest ratio and Q4 the highest. All-cause mortality after initiating dialysis was compared using the log-rank test. All-cause mortality of Q1, Q2, and Q3 was compared with that of Q4 using multivariate Cox proportional hazard regression analysis. Moreover, we compared the renal parameters including BUN/Cr ratio, eGFR, and creatinine clearance for sensitivity and specificity using receiver operative characteristic (ROC) curve.

RESULTS

Significant differences were observed in all-cause mortality among the four groups (p < 0.001). Multivariate analysis revealed that all-cause mortality was significantly higher in Q4 than in Q1 [hazard ratio (HR) = 1.82, 95% confidence interval (CI) 1.24-2.67, p = 0.002]. The increase in BUN/Cr ratio was positively associated with mortality (HR 1.04, 95% CI 1.02-1.06, p = 0.002). The sensitivity and specificity of BUN/Cr ratio for 180, 365, 730, and 1095 days mortality ranged between 0.60-0.72 and 0.59-0.71, respectively. The area under the curve of BUN/Cr for all-cause mortality was the highest among the renal parameters.

CONCLUSION

The BUN/Cr ratio at the time of initiation of dialysis was associated with all-cause mortality.

摘要

背景

一些研究表明，开始透析时的估计肾小球滤过率（eGFR）与死亡率相关。然而，血尿素氮与血清肌酐比值（BUN/Cr）和死亡率之间的关系尚不清楚。

方法

该研究为多中心前瞻性队列分析，纳入1520例患者。根据透析开始时的BUN/Cr比值将患者分为四个四分位数，Q1比值最低，Q4比值最高。使用对数秩检验比较开始透析后的全因死亡率。采用多变量Cox比例风险回归分析比较Q1、Q2和Q3与Q4的全因死亡率。此外，我们使用受试者操作特征（ROC）曲线比较了包括BUN/Cr比值、eGFR和肌酐清除率在内的肾脏参数的敏感性和特异性。

结果

四组间全因死亡率存在显著差异（p < 0.001）。多变量分析显示，Q4的全因死亡率显著高于Q1 [风险比（HR）= 1.82，95%置信区间（CI）1.24 - 2.67，p = 0.002]。BUN/Cr比值升高与死亡率呈正相关（HR 1.04，95% CI 1.02 - 1.06，p = 0.002）。BUN/Cr比值对180、365、730和1095天死亡率的敏感性和特异性分别在0.60 - 0.72和0.59 - 0.71之间。在肾脏参数中，BUN/Cr比值的全因死亡率曲线下面积最高。