Iimori Soichiro, Naito Shotaro, Noda Yumi, Sato Hidehiko, Nomura Naohiro, Sohara Eisei, Okado Tomokazu, Sasaki Sei, Uchida Shinichi, Rai Tatemitsu
Department of Nephrology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Department of Nephrology, Nitobe Memorial Nakano General Hospital, Nakano-ku, Tokyo, Japan.
PLoS One. 2018 Jan 17;13(1):e0190493. doi: 10.1371/journal.pone.0190493. eCollection 2018.
BACKGROUND: Although lower estimated glomerular filtration rate (eGFR) and higher proteinuria are high risks for mortality and kidney outcomes, the prognosis of chronic kidney disease (CKD) in patients with normal-range proteinuria remains unclear. METHODS: In this prospective cohort study, 1138 newly visiting stage G2-G5 CKD patients were stratified into normal-range and abnormal-range proteinuria groups. Study endpoints were CKD progression (>50% eGFR loss or initiation of dialysis), cardiovascular events, and all-cause death. RESULTS: In total, 927 patients who were followed for >6 months were included in the analysis. The mean age was 67 years, and 70.2% were male. During a median follow-up of 35 months, CKD progression, cardiovascular events, and mortality were observed in 223, 110, and 55 patients, respectively. Patients with normal-range proteinuria had a significantly lower risk for CKD progression (hazard ratio, 0.20; 95% confidence interval, 0.10-0.38) than those with abnormal-proteinuria by multivariate Cox proportional hazard analysis. We also analyzed patients with normal-range proteinuria (n = 351). Nephrosclerosis was the most frequent cause of CKD among all patients with normal-range proteinuria (59.7%). During a median follow-up of 36 months, CKD progression, cardiovascular events, and mortality were observed in 10, 28, and 18 patients, respectively. The Kaplan-Meyer analysis demonstrated that the risks of CKD progression and cardiovascular events were not significantly different among CKD stages, whereas the risk of death was significantly higher in patients with advanced-stage CKD. Multivariate Cox proportional hazard analysis showed that the risk of three endpoints did not significantly differ among CKD stages. CONCLUSION: Newly visiting CKD patients with normal-range proteinuria, who tend to be overlooked during health checkups did not exhibit a decrease in kidney function even in advanced CKD stages under specialized nephrology care.
背景:尽管估算肾小球滤过率(eGFR)降低和蛋白尿增加是死亡和肾脏预后的高风险因素,但蛋白尿处于正常范围的慢性肾脏病(CKD)患者的预后仍不明确。 方法:在这项前瞻性队列研究中,1138例新就诊的G2 - G5期CKD患者被分为蛋白尿正常范围组和异常范围组。研究终点为CKD进展(eGFR降低>50%或开始透析)、心血管事件和全因死亡。 结果:总共927例随访时间>6个月的患者纳入分析。平均年龄为67岁,男性占70.2%。在中位随访35个月期间,分别有223例、110例和55例患者出现CKD进展、心血管事件和死亡。通过多变量Cox比例风险分析,蛋白尿正常范围组患者发生CKD进展的风险(风险比,0.20;95%置信区间,0.10 - 0.38)显著低于蛋白尿异常组患者。我们还对蛋白尿正常范围组患者(n = 351)进行了分析。在所有蛋白尿正常范围组患者中,肾硬化是CKD最常见的病因(59.7%)。在中位随访36个月期间,分别有10例、28例和18例患者出现CKD进展、心血管事件和死亡。Kaplan - Meyer分析表明,CKD各阶段之间CKD进展和心血管事件的风险无显著差异,而晚期CKD患者的死亡风险显著更高。多变量Cox比例风险分析显示,CKD各阶段三个终点事件的风险无显著差异。 结论:新就诊的蛋白尿正常范围的CKD患者在健康检查中容易被忽视,即使在专科肾脏病护理下处于晚期CKD阶段,其肾功能也未出现下降。
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