在儿童慢性肾脏病（CKiD）队列研究中，体重减轻、肾功能下降与终末期肾病（ESRD）风险之间的关联。
Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study.
机构信息
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA.
出版信息
Am J Kidney Dis. 2018 May;71(5):648-656. doi: 10.1053/j.ajkd.2017.08.013. Epub 2017 Nov 11.
BACKGROUND
Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD).
STUDY DESIGN
Observational cohort study.
SETTING & PARTICIPANTS: We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study.
PREDICTORS
Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m in logistic regression models.
OUTCOMES
Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models.
RESULTS
During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m. When eGFR decreased to <35mL/min/1.73m, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1).
LIMITATIONS
Observational nature of our study, lack of longitudinal assessments of inflammatory markers.
CONCLUSIONS
In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.
背景
厌食症和营养不良与慢性肾脏病（CKD）患儿的不良结局相关。
研究设计
观察性队列研究。
研究场所和参与者
我们评估了 854 名参与者在 2005 年至 2013 年 CKiD 研究中的变化，这些参与者的肾小球滤过率（eGFR）随肾功能下降，其与终末期肾脏疾病（ESRD）的风险相关。
预测指标
使用混合模型进行轨迹分析时，血清肌酐浓度估计肾小球滤过率（eGFR）的重复测量；eGFR 降低至<35mL/min/1.73m 后 BMI z 分数（每年）的变化。
结局
在我们的轨迹分析中，BMI z 分数的重复测量（反映体重状况）；在逻辑回归模型中，ESRD。
结果
在平均 3.4 年的纵向随访期间，BMI z 分数在 eGFR 降低至<35mL/min/1.73m 之前保持稳定。当 eGFR 降低至<35mL/min/1.73m 时，eGFR 每降低 10mL/min/1.73m，BMI z 分数平均下降 0.13（95%CI，0.09-0.17）。与 eGFR≥35mL/min/1.73m 时的体重轨迹相比，这有统计学意义（P<0.001）。在 eGFR 降低至<35mL/min/1.73m 后体重明显下降（定义为 BMI z 分数每年下降>0.2）的儿童和青少年中，ESRD 的几率是 BMI z 分数稳定（每年 BMI z 分数变化 0-0.1）参与者的 3.28 倍（95%CI，1.53-7.05）。
局限性
我们研究的观察性质，缺乏对炎症标志物的纵向评估。
结论
在患有 CKD 的儿童和青少年中，体重减轻主要发生在 eGFR 降低至<35mL/min/1.73m 时，这种体重减轻与 ESRD 的风险增加相关。需要进一步的研究来确定体重减轻与儿童和青少年向 ESRD 更快速进展之间关联的原因。
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