Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy.
Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy.
Nutrients. 2021 Aug 16;13(8):2811. doi: 10.3390/nu13082811.
Chronic obstructive pulmonary disease (COPD) patients have multiple comorbidities which may affect renal function. Chronic kidney disease (CKD) is a risk factor for adverse outcomes in COPD patients. The predictors of CKD in COPD are not well investigated.
A multicenter observational cohort study including patients affected by COPD (GOLD stages 1 and 2) was carried out. Principal endpoints were the incidence of CKD, as defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m, and the rapid decline of eGFR >5 mL/min/1.73 m/year.
We enrolled 707 outpatients. Overall, 157 (22.2%) patients had CKD at baseline. Patients with CKD were older, with higher serum uric acid (UA) levels, and lower FEV. During a mean follow-up of 52.3 ± 30.2 months, 100 patients developed CKD, and 200 patients showed a rapid reduction of eGFR. Multivariable Cox regression analysis displayed that UA (hazard ratio (HR) 1.148, < 0.0001) and diabetes (HR 1.050, < 0.0001) were predictors of incident CKD. The independent predictors of rapidly declining renal function were represented by an increase of 1 mg/dL in UA (odds ratio (OR) 2.158, < 0.0001)), an increase of 10 mL/min/1.73 m in baseline eGFR (OR 1.054, < 0.0001) and the presence of diabetes (OR 1.100, < 0.009).
This study shows that COPD patients have a significant worsening of renal function over time and that UA and diabetes were the two strongest predictors. Optimal management of these risk factors may reduce the incidence of CKD in this population thus probably improving clinical outcome.
慢性阻塞性肺疾病（COPD）患者合并多种合并症，可能影响肾功能。慢性肾脏病（CKD）是 COPD 患者不良结局的危险因素。预测 COPD 患者发生 CKD 的因素尚未得到充分研究。
进行了一项多中心观察性队列研究，纳入了患有 COPD（GOLD 1 期和 2 期）的患者。主要终点是 CKD 的发生率，定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m2，以及 eGFR 每年快速下降>5 mL/min/1.73 m/年。
我们纳入了 707 名门诊患者。总体而言，157 名（22.2%）患者基线时患有 CKD。CKD 患者年龄较大，血清尿酸（UA）水平较高，FEV1 较低。在平均 52.3±30.2 个月的随访期间，有 100 名患者发生 CKD，有 200 名患者 eGFR 快速下降。多变量 Cox 回归分析显示，UA（危险比（HR）1.148，<0.0001）和糖尿病（HR 1.050，<0.0001）是 CKD 发生的预测因素。UA 增加 1mg/dL（优势比（OR）2.158，<0.0001）、基线 eGFR 增加 10mL/min/1.73 m（OR 1.054，<0.0001）和存在糖尿病（OR 1.100，<0.009）是肾功能快速下降的独立预测因素。
这项研究表明，随着时间的推移，COPD 患者的肾功能会显著恶化，UA 和糖尿病是两个最强的预测因素。对这些危险因素进行最佳管理可能会降低该人群的 CKD 发生率，从而可能改善临床结局。
