Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka.
Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka.
PLoS One. 2021 Apr 14;16(4):e0249539. doi: 10.1371/journal.pone.0249539. eCollection 2021.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with 'traditional' chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.
心血管疾病 (CVD) 是“传统”慢性肾脏病 (CKD) 患者发病率和死亡率的主要原因。然而，慢性肾脏病病因不明 (CKDu)，是一种管状间质性肾病，通常很少出现蛋白尿，高血压或血管疾病的发生率也不高，尚不清楚 CVD 的发生率是否相似。本研究旨在确定 CKDu 患者 CVD 的患病率和风险。这项横断面研究包括在 CKDu 流行地区的两个肾脏诊所就诊的确诊 CKDu 患者。详细的病史、血压、心电图 (静息和六分钟剧烈步行)、超声心动图、适当的实验室参数和病历回顾用于在基线时收集数据。采用世界卫生组织/泛美卫生组织心血管风险计算器来确定 CVD 的未来风险。这些诊所共记录了 132 名 CKDu 患者，其中 119 名同意参与研究。患者的平均年龄为 52(±9.5)岁，平均 eGFR 为 51.1(±27.61)；大多数患者 (81.5%(n=97)) 为男性。34 名患者 (28.6%) 有缺血性心脏病 (IHD) 证据。肌钙蛋白 I(p=0.02)、年龄>50 岁 (p=0.01) 和高尿酸血症 (p=0.01) 与 CKDu 中的 IHD 显著相关。左心室肥厚报告为 20.2%(n=24)。根据风险计算器，97%的入组患者在未来 10 年内发生心血管事件的风险较低(<10%)。CKDu 患者 CVD 的患病率和风险较低，这意味着大多数患者可能会存活至终末期肾病。我们的研究结果强调了制定策略以最小化 CKDu 进展为终末期肾病的必要性。
