Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.
Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Nephrol Dial Transplant. 2019 Feb 1;34(2):277-286. doi: 10.1093/ndt/gfy058.
The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study was designed to investigate the determinants of prognosis and care of patients referred to nephrologists with moderate and advanced chronic kidney disease (CKD). We examined their baseline risk profile and experience.
We collected bioclinical and patient-reported information from 3033 outpatients with CKD and estimated glomerular filtration rates (eGFRs) of 15-60 mL/min/1.73 m2 treated at 40 nationally representative public and private facilities.
The patients' median age was 69 (60-76) years, 65% were men, their mean eGFR was 33 mL/min/1.73 m2, 43% had diabetes, 24% had a history of acute kidney injury (AKI) and 57% had uncontrolled blood pressure (BP; >140/90 mmHg). Men had worse risk profiles than women and were more likely to be past or current smokers (73% versus 34%) and have cardiovascular disease (59% versus 42%), albuminuria >30 mg/mmol (or proteinuria > 50) (40% versus 30%) (all P < 0.001) and a higher median risk of end-stage renal disease within 5 years, predicted by the kidney failure risk equation {12% [interquartile range (IQR) 3-37%] versus 9% [3-31%], P = 0.008}. During the previous year, 60% of patients reported one-to-two nephrologist visits and four or more general practitioner visits; only 25% saw a dietician and 75% were prescribed five or more medications daily. Physical and mental quality of life (QoL) were poor, with scores <50/100.
The CKD-REIN study highlights high-risk profiles of cohort members and identifies several priorities, including improving BP control and dietary counselling and increasing doctors' awareness of AKI, polypharmacy and QoL.
ClinicalTrials.gov identifier: NCT03381950.
法国慢性肾脏病-肾脏流行病学和信息网络（CKD-REIN）队列研究旨在探讨中重度慢性肾脏病（CKD）患者转至肾病学家处就诊的预后和治疗决定因素。我们研究了他们的基线风险特征和就诊经历。
我们收集了 3033 例在 40 家具有代表性的公立和私立医疗机构就诊、估算肾小球滤过率（eGFR）为 15-60ml/min/1.73m2 的 CKD 门诊患者的生物临床和患者报告信息。
患者的中位年龄为 69（60-76）岁，65%为男性，平均 eGFR 为 33ml/min/1.73m2，43%患有糖尿病，24%有急性肾损伤（AKI）病史，57%血压未得到控制（＞140/90mmHg）。男性的风险状况较女性差，更有可能是既往或当前吸烟者（73%比 34%），患有心血管疾病（59%比 42%），白蛋白尿＞30mg/mmol（或蛋白尿＞50mg/g）（40%比 30%）（均 P＜0.001），且应用肾脏病预后方程预测的 5 年内进入终末期肾病的中位风险更高{12%[四分位距（IQR）3-37%]比 9%[3-31%]，P=0.008}。在过去的一年中，60%的患者报告了 1-2 次与肾病医生的就诊，以及 4 次或更多次全科医生就诊；仅有 25%的患者看过营养师，75%的患者每天服用 5 种或更多药物。身体和精神生活质量（QoL）较差，评分＜50/100。
CKD-REIN 研究强调了队列成员的高危特征，并确定了一些重点，包括改善血压控制和饮食咨询，提高医生对 AKI、多药治疗和 QoL 的认识。
ClinicalTrials.gov 标识符：NCT03381950。
