Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea.
Atherosclerosis. 2021 Oct;335:53-61. doi: 10.1016/j.atherosclerosis.2021.08.036. Epub 2021 Aug 27.
Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD).
This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60-89; G3: 30-59; G4: 15-29; G5: <15 mL/min/1.73 m without kidney replacement therapy). The difference in eGFR (eGFR) was calculated by subtracting the cystatin C-based eGFR (eGFR) from the creatinine-based eGFR (eGFR). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death.
During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFR tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28-3.51) than the lowest tertile when adjusted for eGFR, eGFR, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03-1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFR was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01-1.05).
A large positive difference between eGFR and eGFR was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFR.
肾功能下降是心血管疾病（CVD）的一个重要危险因素。然而，当基于肌酐和胱抑素 C 的估算肾小球滤过率（eGFR）之间存在差距时，评估 CVD 风险可能较为困难。本研究旨在探讨慢性肾脏病（CKD）患者 eGFR 差值与主要不良心血管事件（MACE）之间的关系。
本前瞻性队列研究纳入了 2076 名根据 KDIGO 指南确定的 CKD 患者（eGFR 分类：G1：≥90；G2：60-89；G3：30-59；G4：15-29；G5：<15 mL/min/1.73 m，无肾脏替代治疗）。eGFR 差值（eGFR）通过减去基于胱抑素 C 的 eGFR（eGFR）计算得出。主要结局为 MACE，定义为非致死性急性心肌梗死和不稳定型心绞痛、卒中等、充血性心力衰竭、有症状心律失常和心脏性死亡。
在中位随访 4.1 年期间，147 名患者发生了 MACE（发生率为 15.0/1000 患者-年）。当患者按基线 eGFR 三分位分组时，与最低三分位相比，最高三分位的 MACE 风险显著更高（风险比，2.12；95%置信区间 [CI]，1.28-3.51），且校正 eGFR、eGFR 或基于肌酐和胱抑素 C 的 eGFR 后，结果仍具有统计学意义。最高三分位患者的基线冠状动脉钙化（CAC）评分明显高于最低三分位（比值比 [OR]，1.38；95% CI，1.03-1.86）。此外，978 名患者在第 4 年时同时具有基线和随访 CAC 数据。在该亚组中，基线 eGFR 与 CAC 进展速度加快（≥50/年）显著相关（OR，1.03；95% CI，1.01-1.05）。
在 CKD 患者中，eGFR 与 eGFR 之间存在较大的正值差值与 MACE 风险增加和 CAC 进展加速相关。因此，对于 eGFR 较高的患者，需要密切监测 CVD。
