Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, Shahid Chamran Highway, P.O. Box: 19395-4763, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Transl Med. 2017 Nov 28;15(1):240. doi: 10.1186/s12967-017-1346-x.
Chronic kidney disease (CKD) is a growing public health challenges worldwide. Various studies have investigated risk factors of incident CKD; however, a very few studies examined interaction between these risk factors. In an attempt to clarify the potential interactions between risk factors of CKD, we performed survival tree analysis.
A total of 8238 participants (46.1% men) aged > 20 years without CKD at baseline [(1999-2001) and (2002-2005)], were followed until 2014. The first occurrence of CKD, defined as the estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m, was set as the main outcome. Multivariable Cox proportional hazard (Cox PH) regression was used to identify significant independent predictors of CKD; moreover, survival tree analysis was performed to gain further insight into the potential interactions between predictors.
The crude incidence rates of CKD were 20.2 and 35.2 per 1000 person-years in men and women, respectively. The Cox PH identified the main effect of significant predictors of CKD incidence in men and women. In addition, using a limited number of predictors, survival trees identified 12 and 10 subgroups among men and women, respectively, with different survival probability. Accordingly, a group of men with eGFR > 74 ml/min/1.73 m, age ≤ 46 years, low level of physical activity, waist circumference ≤ 100 cm and FPG ≤ 4.7 mmol/l had the lowest risk of CKD incidence; while men with eGFR ≤ 63.4 ml/min/1.73 m, age > 50 years had the highest risk for CKD compared to men in the lowest risk group [hazard ratio (HR), 70.68 (34.57-144.52)]. Also, a group of women aged ≤ 45 years and eGFR > 83.5 ml/min/1.73 m had the lowest risk; while women with age > 48 years and eGFR ≤ 69 ml/min/1.73 m had the highest risk compared to low risk group [HR 27.25 (19.88-37.34)].
In this post hoc analysis, we found the independent predictors of CKD using Cox PH; furthermore, by applying survival tree analysis we identified several numbers of homogeneous subgroups with different risk for incidence of CKD. Our study suggests that two methods can be used simultaneously to provide new insights for intervention programs and improve clinical decision making.
慢性肾脏病（CKD）是全球日益严重的公共卫生挑战。多项研究调查了 CKD 的发病风险因素；然而，很少有研究探讨这些风险因素之间的相互作用。为了阐明 CKD 发病风险因素之间的潜在相互作用，我们进行了生存树分析。
共有 8238 名年龄大于 20 岁且基线时无 CKD（1999-2001 年和 2002-2005 年）的参与者，随访至 2014 年。以估算肾小球滤过率（eGFR）<60ml/min/1.73m 为主要结局，将 CKD 的首次发生定义为主要结局。多变量 Cox 比例风险（Cox PH）回归用于确定 CKD 的显著独立预测因素；此外，还进行了生存树分析，以深入了解预测因素之间的潜在相互作用。
男性和女性的 CKD 粗发病率分别为每 1000 人年 20.2 和 35.2。Cox PH 确定了男性和女性 CKD 发病的主要预测因素。此外，使用少量预测因素，生存树分别在男性和女性中确定了 12 个和 10 个亚组，这些亚组的生存概率不同。相应地，一组男性的 eGFR>74ml/min/1.73m、年龄≤46 岁、低体力活动水平、腰围≤100cm 和 FPG≤4.7mmol/l，发生 CKD 的风险最低；相比之下，eGFR≤63.4ml/min/1.73m、年龄>50 岁的男性与最低风险组相比，发生 CKD 的风险最高[风险比（HR），70.68（34.57-144.52）]。此外，年龄≤45 岁且 eGFR>83.5ml/min/1.73m 的一组女性风险最低；相比之下，年龄>48 岁且 eGFR≤69ml/min/1.73m 的女性与低风险组相比，发生 CKD 的风险最高[HR 27.25（19.88-37.34）]。
在本事后分析中，我们使用 Cox PH 确定了 CKD 的独立预测因素；此外，通过应用生存树分析，我们确定了具有不同 CKD 发病风险的多个同质亚组。我们的研究表明，这两种方法可以同时使用，为干预计划提供新的见解，并改善临床决策。
Zotero 插件
