Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Soc Nephrol. 2020 Dec;31(12):2912-2923. doi: 10.1681/ASN.2020040476. Epub 2020 Oct 6.
Slopes of eGFR have been associated with increased risks of death and cardiovascular events in a U-shaped fashion. Poor outcomes in individuals with rising eGFR are potentially attributable to sarcopenia, hemodilution, and other indicators of clinical deterioration.
To investigate the association between eGFR slopes and risks of death or cardiovascular events, accounting for multiple confounders, we studied 2738 individuals with moderate to severe CKD participating in the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used linear, mixed-effects models to estimate slopes with up to four annual eGFR assessments, and Cox proportional hazards models to investigate the association between slopes and the risks of death and cardiovascular events.
Slopes of eGFR had a bell-shaped distribution (mean [SD], -1.5 [-2] ml/min per 1.73 m per year). Declines of eGFR that were steeper than the average decline associated with progressively increasing risks of death (hazard ratio [HR], 1.23; 95% confidence interval [95% CI], 1.09 to 1.39; for a slope 1 SD below the average) and cardiovascular events (HR, 1.19; 95% CI, 1.03 to 1.38). Rises of eGFR or declines lower than the average decline were not associated with the risk of death or cardiovascular events.
In a cohort of individuals with moderate to severe CKD, we observed steep declines of eGFR were associated with progressively increasing risks of death and cardiovascular events; however, we found no increased risks associated with eGFR improvement. These findings support the potential value of eGFR slopes in clinical assessment of adults with CKD.
eGFR 的斜率与 U 型方式的死亡和心血管事件风险增加相关。eGFR 升高的个体的不良预后可能归因于肌肉减少症、血液稀释和其他临床恶化指标。
为了研究 eGFR 斜率与死亡或心血管事件风险之间的关联，我们考虑了多个混杂因素，对参加多中心慢性肾脏不全队列（CRIC）研究的 2738 名中重度 CKD 患者进行了研究。我们使用线性、混合效应模型来估计多达四次的年度 eGFR 评估斜率，并使用 Cox 比例风险模型来研究斜率与死亡和心血管事件风险之间的关联。
eGFR 斜率呈钟形分布（平均值[标准差]，-1.5[-2]ml/min per 1.73 m per year）。eGFR 的下降速度超过与死亡率（风险比[HR]，1.23；95%置信区间[95%CI]，1.09 至 1.39；斜率比平均水平低 1 个标准差）和心血管事件（HR，1.19；95%CI，1.03 至 1.38）呈递增关系的平均下降速度与风险增加相关。eGFR 的升高或低于平均下降速度与死亡或心血管事件风险无关。
在中重度 CKD 患者队列中，我们观察到 eGFR 的急剧下降与死亡和心血管事件风险的逐渐增加相关；然而，我们没有发现与 eGFR 改善相关的风险增加。这些发现支持 eGFR 斜率在成人 CKD 临床评估中的潜在价值。
