血浆草酸盐作为原发性高草酸尿症队列肾功能下降的预测指标。
Plasma Oxalate as a Predictor of Kidney Function Decline in a Primary Hyperoxaluria Cohort.
机构信息
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
Int J Mol Sci. 2020 May 20;21(10):3608. doi: 10.3390/ijms21103608.
This retrospective analysis investigated plasma oxalate (POx) as a potential predictor of end-stage kidney disease (ESKD) among primary hyperoxaluria (PH) patients. PH patients with type 1, 2, and 3, age 2 or older, were identified in the Rare Kidney Stone Consortium (RKSC) PH Registry. Since POx increased with falling estimated glomerular filtration rate (eGFR), patients were stratified by chronic kidney disease (CKD) subgroups (stages 1, 2, 3a, and 3b). POx values were categorized into quartiles for analysis. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for risk of ESKD were estimated using the Cox proportional hazards model with a time-dependent covariate. There were 118 patients in the CKD1 group (nine ESKD events during follow-up), 135 in the CKD 2 (29 events), 72 in CKD3a (34 events), and 45 patients in CKD 3b (31 events). During follow-up, POx Q4 was a significant predictor of ESKD compared to Q1 across CKD2 (HR 14.2, 95% CI 1.8-115), 3a (HR 13.7, 95% CI 3.0-62), and 3b stages (HR 5.2, 95% CI 1.1-25), < 0.05 for all. Within each POx quartile, the ESKD rate was higher in Q4 compared to Q1-Q3. In conclusion, among patients with PH, higher POx concentration was a risk factor for ESKD, particularly in advanced CKD stages.
这项回顾性分析研究了血浆草酸盐（POx）是否可作为原发性高草酸尿症（PH）患者终末期肾病（ESKD）的潜在预测指标。在罕见肾脏病石联盟（RKSC）PH 登记处，确定了年龄≥2 岁的 PH 患者，包括 1 型、2 型和 3 型。由于 POx 随着估算肾小球滤过率（eGFR）的降低而升高，因此根据慢性肾脏病（CKD）亚组（1 期、2 期、3a 期和 3b 期）对患者进行分层。为了进行分析，将 POx 值分为四等分。使用时间依赖性协变量的 Cox 比例风险模型估计 ESKD 风险的风险比（HR）和 95%置信区间（95%CI）。在 CKD1 组中有 118 例患者（随访期间发生 9 例 ESKD 事件），在 CKD2 组中有 135 例（29 例事件），在 CKD3a 组中有 72 例（34 例事件），在 CKD3b 组中有 45 例（31 例事件）。在随访期间，与 CKD2（HR 14.2，95%CI 1.8-115）、3a（HR 13.7，95%CI 3.0-62）和 3b 期（HR 5.2，95%CI 1.1-25）相比，POx Q4 是 ESKD 的显著预测指标，所有组均 < 0.05。在每个 POx 四分位组中，与 Q1-Q3 相比，Q4 的 ESKD 发生率更高。总之，在 PH 患者中，较高的 POx 浓度是 ESKD 的危险因素，尤其是在 CKD 晚期。
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