Østergaard Helena Bleken, Westerink Jan, Verhaar Marianne C, Bots Michiel L, Asselbergs Folkert W, de Borst Gert J, Kappelle L Jaap, Visseren Frank L J, van der Leeuw Joep
Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
J Nephrol. 2021 Oct;34(5):1511-1520. doi: 10.1007/s40620-021-00996-1. Epub 2021 Mar 13.
Patients with cardiovascular disease (CVD) are at increased risk of end-stage kidney disease (ESKD). Insights into the incidence and role of modifiable risk factors for end-stage kidney disease may provide means for prevention in patients with cardiovascular disease.
We included 8402 patients with stable cardiovascular disease. Incidence rates (IRs) for end-stage kidney disease were determined stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of end-stage kidney disease for the different determinants.
Sixty-five events were observed with a median follow-up of 8.6 years. The overall incidence rate of end-stage kidney disease was 0.9/1000 person-years. Patients with polyvascular disease had the highest incidence rate (1.8/1000 person-years). Smoking (Hazard ratio (HR) 1.87; 95% CI 1.10-3.19), type 2 diabetes (HR 1.81; 95% CI 1.05-3.14), higher systolic blood pressure (HR 1.37; 95% CI 1.24-1.52/10 mmHg), lower estimated glomerular filtration rate (eGFR) (HR 2.86; 95% CI 2.44-3.23/10 mL/min/1.73 m) and higher urine albumin/creatinine ratio (uACR) (HR 1.19; 95% CI 1.15-1.23/10 mg/mmol) were independently associated with elevated risk of end-stage kidney disease. Body mass index (BMI), waist circumference, non-HDL-cholesterol and exercise were not independently associated with risk of end-stage kidney disease.
Incidence of end-stage kidney disease in patients with cardiovascular disease varies according to vascular disease location. Several modifiable risk factors for end-stage kidney disease were identified in patients with cardiovascular disease. These findings highlight the potential of risk factor management in patients with manifest cardiovascular disease.
心血管疾病（CVD）患者发生终末期肾病（ESKD）的风险增加。深入了解终末期肾病可改变危险因素的发生率及其作用，可能为心血管疾病患者提供预防手段。
我们纳入了8402例稳定型心血管疾病患者。根据血管疾病部位分层确定终末期肾病的发病率（IRs）。采用Cox比例风险模型评估不同决定因素导致终末期肾病的风险。
在中位随访8.6年期间观察到65例事件。终末期肾病的总体发病率为0.9/1000人年。患有多血管疾病的患者发病率最高（1.8/1000人年）。吸烟（风险比（HR）1.87；95%置信区间1.10 - 3.19）、2型糖尿病（HR 1.81；95%置信区间1.05 - 3.14）、较高的收缩压（HR 1.37；95%置信区间1.24 - 1.52/10 mmHg）、较低的估计肾小球滤过率（eGFR）（HR 2.86；95%置信区间2.44 - 3.23/10 mL/min/1.73 m²）和较高的尿白蛋白/肌酐比值（uACR）（HR 1.19；95%置信区间1.15 - 1.23/10 mg/mmol）与终末期肾病风险升高独立相关。体重指数（BMI）、腰围、非高密度脂蛋白胆固醇和运动与终末期肾病风险无独立相关性。
心血管疾病患者终末期肾病的发病率因血管疾病部位而异。在心血管疾病患者中确定了几种终末期肾病的可改变危险因素。这些发现凸显了对已患心血管疾病患者进行危险因素管理的潜力。
