Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France.
Université de Paris, Paris, France; Department of Physiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; INSERM U1149, Centre de recherche sur l'inflammation, Paris, France.
Kidney Int. 2019 Oct;96(4):1020-1029. doi: 10.1016/j.kint.2019.06.017. Epub 2019 Jul 16.
Volume overload has been shown to be an independent risk factor for mortality in patients receiving chronic dialysis, but data in non-dialysis patients are scarce. Therefore we evaluated the prognostic value of extracellular fluid (ECF) volume for chronic kidney disease (CKD) progression and mortality in a prospective hospital-based cohort with CKD stage 1-4 (NephroTest Study). ECF (scaled to body surface area) and the measured glomerular filtration rate (mGFR) were determined using the distribution volume and clearance of 51Cr-EDTA, respectively. Cause-specific Cox and linear mixed-effect regression models were used to analyze the association of ECF with end-stage kidney disease (ESKD) and mortality, and with mGFR decline, respectively. The 1593 patients were mean age 58.8 years, 67% were men, mean mGFR of 43.6 mL/min/1.73m and mean ECF 15.1 L/1.73m. After a median follow-up of 5.3 years, ESKD occurred in 324 patients and 185 patients died before ESKD. In multivariable analysis, ECF was significantly associated with the risk of ESKD (hazard ratio per 1L/1.73m increase: 1.14; 95% confidence interval [1.07; 1.21]) and with a faster GFR decline (adjusted mean difference in mGFR slope per 1L/1.73m increase -0.14 [-0.23; -0.05] mL/min/year). The relationship of ECF with mortality was non-linear and not significant (per 1L/1.73m increase 0.92, [0.73; 1.16]), below 15L/1.73m, but significant (1.28; [1.14-1.45]) above 15L/1.73m. Thus, in this large cohort of carefully phenotyped patients with CKD, ECF was an independent risk factor of CKD progression and mortality. Hence, close monitoring and treatment of fluid overload are important for the clinical management of patients with non-dialysis CKD.
容量过负荷已被证实是接受慢性透析治疗的患者死亡的独立危险因素，但非透析患者的数据却很少。因此，我们在一个前瞻性、基于医院的 CKD 1-4 期患者队列（NephroTest 研究）中评估了细胞外液（ECF）容量对 CKD 进展和死亡率的预后价值。使用 51Cr-EDTA 的分布容积和清除率分别确定细胞外液（按体表面积缩放）和测量的肾小球滤过率（mGFR）。使用特定原因的 Cox 和线性混合效应回归模型分别分析 ECF 与终末期肾病（ESKD）和死亡率以及 mGFR 下降的关系。1593 例患者的平均年龄为 58.8 岁，67%为男性，平均 mGFR 为 43.6 mL/min/1.73m，平均 ECF 为 15.1 L/1.73m。中位随访 5.3 年后，324 例患者发生 ESKD，185 例患者在发生 ESKD 前死亡。多变量分析显示，ECF 与 ESKD 风险显著相关（每增加 1L/1.73m 的危险比：1.14；95%置信区间[1.07；1.21]），与 GFR 下降速度更快相关（每增加 1L/1.73m，mGFR 斜率的调整平均差异-0.14 [-0.23；-0.05] mL/min/年）。ECF 与死亡率的关系是非线性的，且不显著（每增加 1L/1.73m，0.92 [0.73；1.16]），低于 15L/1.73m，但显著（1.28 [1.14-1.45]），高于 15L/1.73m。因此，在这个精心表型的 CKD 大队列中，ECF 是 CKD 进展和死亡率的独立危险因素。因此，密切监测和治疗液体过负荷对于非透析 CKD 患者的临床管理非常重要。
