Kidney Center, Turku University Hospital and University of Turku, Turku, Finland.
Kidney Center, Turku University Hospital and University of Turku, Turku, Finland,
Am J Nephrol. 2020;51(9):726-735. doi: 10.1159/000509582. Epub 2020 Aug 10.
Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study.
One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients.
The duration of follow-up was 42 ± 17 months (range 134-2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e' ratio, and albumin.
Stress ergometry performance, abdominal aortic calcification score, E/e' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
患有晚期慢性肾脏病（CKD 4-5 期）的患者死亡风险增加。为了研究全因死亡率的决定因素，我们前瞻性地招募了 210 名未接受透析的 CKD 4-5 期连续患者进入慢性动脉疾病、生活质量和慢性肾损伤死亡率研究（CADKID）。
174 名患者接受了最大自行车功量应激测试和侧位腰椎 X 线检查，以研究腹主动脉钙化评分和超声心动图。156 名患者测量了颈动脉和股动脉内-中膜厚度和弹性以及肱动脉血流介导的扩张。
随访时间为 42 ± 17 个月（范围 134-2217 天）。平均年龄为 61 ± 14 岁，估计肾小球滤过率为 12（11-15）mL/min/1.73 m2。36（21%）名患者在随访期间死亡（死亡时间为 835 ± 372 天）。75 名和 21 名患者分别患有糖尿病和冠心病，除 1 名患者外，所有患者均患有高血压。在各自调整年龄、性别和冠心病的多变量比例风险模型中，死亡率的显著决定因素是肌钙蛋白 T、N 端脑利钠肽前体、最大功量表现、腹主动脉钙化评分、E/e' 比值和白蛋白。
应激功量表现、腹主动脉钙化评分、超声心动图的 E/e'、血浆心脏生物标志物和白蛋白预测晚期 CKD 的死亡率。
