Medical Science, Kawasaki Medical School, Okayama, Japan.
Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
Sci Rep. 2019 Mar 25;9(1):5082. doi: 10.1038/s41598-019-41663-7.
Identifying progressive early chronic kidney disease (CKD) patients at a health checkup is a good opportunity to improve their prognosis. However, it is difficult to identify them using common health tests. This worksite-based cohort study for 7 years in Japan (n = 7465) was conducted to evaluate the progression of CKD. The outcome was aggravation of the KDIGO prognostic category of CKD 7 years later. The subjects were male, 59.1%; age, 50.1 ± 6.3 years; and eGFR, 79 ± 14.4 mL/min/1.73 m. The number of subjects showing CKD progression started to increase from 3 years later. Vector analysis showed that CKD stage G1 A1 was more progressive than CKD stage G2 A1. Bayesian networks showed that the time-series changes in the prognostic category of CKD were related to the outcome. Support vector machines including time-series data of the prognostic category of CKD from 3 years later detected the high possibility of the outcome not only in subjects at very high risks but also in those at low risks at baseline. In conclusion, after the evaluation of kidney function at a health checkup, it is necessary to follow up not only patients at high risks but also patients at low risks at baseline for 3 years and longer.
在体检中识别进展性早期慢性肾脏病（CKD）患者是改善其预后的良好机会。然而，使用常规健康检查来识别他们是困难的。本研究对日本一个工作场所开展了为期 7 年的队列研究（n=7465），旨在评估 CKD 的进展。结局为 7 年后 KDIGO CKD 预后类别加重。受试者为男性，占 59.1%；年龄为 50.1±6.3 岁；eGFR 为 79±14.4mL/min/1.73m。出现 CKD 进展的受试者数量从 3 年后开始增加。向量分析显示 CKD 阶段 G1 A1 比 CKD 阶段 G2 A1 更具进展性。贝叶斯网络显示 CKD 预后类别的时间序列变化与结局相关。包括 3 年后 CKD 预后类别时间序列数据的支持向量机不仅可以检测出极高风险人群的结局发生的高可能性，也可以检测出基线时低风险人群的结局发生的高可能性。总之，在体检评估肾功能后，不仅需要对高风险患者，而且需要对基线时低风险患者进行 3 年及以上的随访。
