Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Osaka, Japan.
Nephrol Dial Transplant. 2020 Jun 1;35(6):987-994. doi: 10.1093/ndt/gfy299.
Serum chloride (Cl) levels confer better prognostic value than serum sodium (Na) levels among patients with heart failure. Little is known about the relationship between serum Cl levels and clinical outcomes among patients with chronic kidney disease (CKD).
This was a retrospective cohort study enrolling patients with Stages G3-G5 CKD who visited the nephrology outpatient department of Osaka University Hospital from April 2005 to December 2014. The main exposure was time-varying serum Cl levels categorized as quartiles. The study outcome was a composite of all-cause death and cardiovascular events.
A total of 2661 patients with CKD were included in the analysis. During a median follow-up of 4.0 years, 284 deaths and 416 cardiovascular events occurred. Compared with patients in the third Cl quartile, those in the first Cl quartile showed a significantly higher risk of the outcome after adjustment for demographics and clinical factors including time-varying serum Na, serum albumin and bicarbonate levels, and use of diuretics and sodium bicarbonate [hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.20-3.81; P = 0.01] and, additionally, anion gap (HR 2.13; 95% CI 1.26-3.57; P = 0.004). Adding serum Cl levels, but not serum Na levels, to the multivariable model significantly improved net reclassification index (0.335; P < 0.001) and integrated discrimination improvement (0.0113; P = 0.01).
Lower serum Cl levels are an independent predictor of death and cardiovascular events. The incremental prognostic value of Cl was superior to that of Na in patients with CKD.
在心力衰竭患者中，血清氯（Cl）水平比血清钠（Na）水平提供更好的预后价值。对于慢性肾脏病（CKD）患者，血清 Cl 水平与临床结局之间的关系知之甚少。
这是一项回顾性队列研究，纳入了 2005 年 4 月至 2014 年 12 月期间在大阪大学医院肾内科门诊就诊的 G3-G5 期 CKD 患者。主要暴露因素为时间变化的血清 Cl 水平，分为四分位数。研究结果是全因死亡和心血管事件的综合结果。
共纳入 2661 例 CKD 患者。在中位随访 4.0 年后，发生 284 例死亡和 416 例心血管事件。与第三 Cl 四分位组患者相比，第一 Cl 四分位组患者在调整人口统计学和临床因素后，包括时间变化的血清 Na、血清白蛋白和碳酸氢盐水平以及利尿剂和碳酸氢钠的使用后，该结局的风险显著更高[风险比（HR）2.13；95%置信区间（CI）1.20-3.81；P=0.01]，并且阴离子间隙（HR 2.13；95% CI 1.26-3.57；P=0.004）。在多变量模型中加入血清 Cl 水平而非血清 Na 水平可显著提高净重新分类指数（0.335；P<0.001）和综合判别改善（0.0113；P=0.01）。
较低的血清 Cl 水平是死亡和心血管事件的独立预测因子。在 CKD 患者中，Cl 的增量预后价值优于 Na。
