Peng Zhangzhe, Wang Jinwei, Yuan Qiongjing, Xiao Xiangcheng, Xu Hui, Xie Yanyun, Wang Wei, Huang Ling, Zhong Yong, Ao Xiang, Zhang Luxia, Zhao Minghui, Tao Lijian, Zhou Qiaoling
Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China.
BMC Nephrol. 2017 Oct 13;18(1):311. doi: 10.1186/s12882-017-0725-0.
This study aimed to compare clinical features and health-related quality of life (HRQoL) in the Chinese chronic kidney disease (CKD) 3 population and determined the necessity of the subdivision of CKD3 in Chinese patients with CKD.
Participants with stage 3 CKD (18-74 years of age) were recruited at 39 clinical centers located at 28 cities in 22 provinces of China. The sociodemographic status, medical history, anthropometric measurements, and lifestyle behaviors were documented at entry, and blood and urine samples were collected. The estimated glomerular filtration rate was calculated using the CKD-EPI creatinine equation. The HRQoL was evaluated using the kidney disease quality-of-life instrument. A linear regression model was used to estimate the association between HRQoL and CKD stages (G3b vs G3a).
The levels of intact parathyroid hormone, systolic blood pressure, uric acid, and high-density lipoprotein cholesterol were statistically significantly higher, whereas the levels of serum bicarbonate and hemoglobin were statistically significantly lower in the G3b group compared with the G3a group. Compared with CKD G3a group, the proportions of subjects with hyperuricemia and anemia were significantly higher in CKD G3b group (61.4% vs. 52.0% and 26.4% vs. 17.9%, respectively, P< 0.01). The HRQoL scores in "physical functioning (PCS)", "symptoms and problems", "effects of the kidney disease" and "burden of the kidney disease" were statistically significantly lower in the CKD G3b group compared with the CKD G3a group (90.88 ± 11.05 vs. 89.30 ± 11.52, 88.29 ± 11.94 vs. 86.49 ± 13.45, 55.86 ± 26.40 vs. 52.10 ± 27.64, 46.56 ± 8.16 vs. 44.51 ± 9.22, respectively, P< 0.01). Further, CKD G3b was associated with a lower score of physical functioning compared with G3a (regression coefficient =-1.12 [95%CI: -2.23, -0.16]).
The preliminary results of this study suggested that modest differences existed in many important clinical features and KDQoL between patients with G3a and G3b CKD in a Chinese population. Also, a significant association between CKD3 subdivision of the disease and PCS was detected. Although further work is needed, we can speculate based on these results the CKD3 subdivision may be clinically meaningful for Chinese patients with CKD.
本研究旨在比较中国慢性肾脏病（CKD）3期患者的临床特征和健康相关生活质量（HRQoL），并确定中国CKD患者中CKD3细分的必要性。
在中国22个省份28个城市的39个临床中心招募3期CKD患者（18 - 74岁）。记录入组时的社会人口统计学状况、病史、人体测量数据和生活方式行为，并采集血液和尿液样本。使用CKD - EPI肌酐方程计算估计肾小球滤过率。使用肾脏病生活质量量表评估HRQoL。采用线性回归模型估计HRQoL与CKD分期（G3b与G3a）之间的关联。
与G3a组相比，G3b组的全段甲状旁腺激素、收缩压、尿酸和高密度脂蛋白胆固醇水平在统计学上显著更高，而血清碳酸氢盐和血红蛋白水平在统计学上显著更低。与CKD G3a组相比，CKD G3b组高尿酸血症和贫血患者的比例显著更高（分别为61.4%对52.0%和26.4%对17.9%，P < 0.01）。与CKD G3a组相比，CKD G3b组在“身体功能（PCS）”、“症状与问题”、“肾脏疾病影响”和“肾脏疾病负担”方面的HRQoL得分在统计学上显著更低（分别为90.88 ± 11.05对89.30 ± 11.52、88.29 ± 11.94对86.49 ± 13.45、55.86 ± 26.40对52.10 ± 27.64、46.56 ± 8.16对44.51 ± 9.22，P < 0.01）。此外，与G3a相比，CKD G3b与更低的身体功能得分相关（回归系数 = -1.12 [95%CI：-2.23，-0.16]）。
本研究的初步结果表明，中国人群中G3a和G3b期CKD患者在许多重要临床特征和KDQoL方面存在适度差异。此外，检测到疾病的CKD3细分与PCS之间存在显著关联。尽管还需要进一步研究，但基于这些结果我们可以推测，CKD3细分对中国CKD患者可能具有临床意义。
