Janmaat Cynthia J, van Diepen Merel, van Hagen Cheyenne Ce, Rotmans Joris I, Dekker Friedo W, Dekkers Olaf M
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
Clin Epidemiol. 2018 May 25;10:613-622. doi: 10.2147/CLEP.S153367. eCollection 2018.
Substantial heterogeneity exists in reported kidney function decline in pre-dialysis chronic kidney disease (CKD). By design, kidney function decline can be studied in CKD 3-5 cohorts or dialysis-based studies. In the latter, patients are selected based on the fact that they initiated dialysis, possibly leading to an overestimation of the true underlying kidney function decline in the pre-dialysis period. We performed a systematic review and meta-analysis to compare the kidney function decline during pre-dialysis in CKD stage 3-5 patients, in these two different study types.
We searched PubMed, EMBASE, Web of Science and Cochrane to identify eligible studies reporting an estimated glomerular filtration rate (eGFR) decline (mL/min/1.73 m) in adult pre-dialysis CKD patients. Random-effects meta-analysis was performed to obtain weighted mean annual eGFR decline.
We included 60 studies (43 CKD 3-5 cohorts and 17 dialysis-based studies). The meta-analysis yielded a weighted annual mean (95% CI) eGFR decline during pre-dialysis of 2.4 (95% CI: 2.2, 2.6) mL/min/1.73 m in CKD 3-5 cohorts compared to 8.5 (95% CI: 6.8, 10.1) in dialysis-based studies (difference 6.0 [95% CI: 4.8, 7.2]).
To conclude, dialysis-based studies report faster mean annual eGFR decline during pre-dialysis than CKD 3-5 cohorts. Thus, eGFR decline data from CKD 3-5 cohorts should be used to guide clinical decision making in CKD patients and for power calculations in randomized controlled trials with CKD progression during pre-dialysis as the outcome.
在已报道的透析前慢性肾脏病（CKD）患者肾功能下降情况中存在显著异质性。从设计角度来看，肾功能下降情况可在CKD 3 - 5期队列研究或基于透析的研究中进行探讨。在后者中，患者是基于开始透析这一事实而被选入的，这可能导致对透析前期真正潜在的肾功能下降情况估计过高。我们进行了一项系统综述和荟萃分析，以比较这两种不同研究类型中CKD 3 - 5期患者透析前的肾功能下降情况。
我们检索了PubMed、EMBASE、科学网和考克兰图书馆，以确定报告成年透析前CKD患者估计肾小球滤过率（eGFR）下降（mL/min/1.73 m²）的符合条件的研究。采用随机效应荟萃分析来获得加权平均每年eGFR下降值。
我们纳入了60项研究（43项CKD 3 - 5期队列研究和17项基于透析的研究）。荟萃分析得出，CKD 3 - 5期队列研究中透析前加权平均每年（95% CI）eGFR下降为2.4（95% CI：2.2，2.6）mL/min/1.73 m²，而基于透析的研究中为8.5（95% CI：6.8，10.1）mL/min/1.73 m²（差值6.0 [95% CI：4.8，7.2]）。
总之，基于透析的研究报告的透析前平均每年eGFR下降速度比CKD 3 - 5期队列研究更快。因此，CKD 3 - 5期队列研究的eGFR下降数据应用于指导CKD患者的临床决策，以及用于以透析前CKD进展为结局的随机对照试验的效能计算。
