伴有和不伴有糖尿病的 CKD 进展的危险因素。
Risk Factors for Progression of CKD with and without Diabetes.
机构信息
Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
出版信息
J Diabetes Res. 2022 Aug 22;2022:9613062. doi: 10.1155/2022/9613062. eCollection 2022.
OBJECTIVE
We aim to identify independent risk factors to predict CKD progression to end stage renal disease (ESRD) in patients with or without diabetes.
METHODS
In this retrospective study, we enrolled CKD stage 3-4 patients between January 2013 and December 2018 and followed them until December 2020 or the initiation of dialysis. We used Kaplan-Meier to plot the survival curve. Univariate and multivariable Cox proportional hazards model was used to explore risk factors affecting the progression of CKD. The final model was used to construct nomogram for predicting CKD progression. Calibration plots and concordance index (C-index) were used to evaluate the accuracy and discrimination of the risk model.
RESULTS
We enrolled 309 CKD patients, including 80 cases in G3a, 98 cases in G3b, and 131 cases in G4. Among them, 141 patients had diabetes and 168 did not. The mean age of patients at enrolled was 57.86 ± 15.10 years, and 67% were male. The median follow-up time was 25.6 months. There were 81 patients (26.2%) that started dialysis in the total CKD cohort, 52 cases (36.9%) in the CKD with diabetes group, and 29 cases (17.3%) in the CKD without diabetes group. Hypoalbuminemia ( =2.655, < 0.001), proteinuria ( =2.592, = 0.042), increased LDL ( =2.494, < 0.001), diabetes ( =2.759, < 0.001), hypertension ( =3.471, = 0.037), and CKD stage ( =2.001, = 0.046) were risk factors for CKD progression to ESRD in the overall population. For those without diabetes, only hypoalbuminemia ( =2.938, = 0.030) was a risk factor for CKD progression to ESRD. For those with diabetes, both hypoalbuminemia ( =2.758, = 0.002), the increased level of LDL ( =3.982, < 0.001), and CKD stage ( =3.781, = 0.001) were risk factors for CKD progression to ESRD. The C-index of the final nomograms was 0.760 ( < 0.001).
CONCLUSIONS
The results from our risk factor model suggest that CKD disease progression can be predicted and early strategic intervention is necessary for CKD patients to avoid renal function deterioration.
目的
本研究旨在确定预测合并或不合并糖尿病的慢性肾脏病（CKD）患者向终末期肾病（ESRD）进展的独立危险因素。
方法
本回顾性研究纳入了 2013 年 1 月至 2018 年 12 月期间 CKD 3-4 期的患者，并对其进行随访，直至 2020 年 12 月或开始透析。我们使用 Kaplan-Meier 绘制生存曲线。采用单因素和多因素 Cox 比例风险模型探讨影响 CKD 进展的危险因素。最后，基于最终模型构建预测 CKD 进展的列线图。校准图和一致性指数（C-index）用于评估风险模型的准确性和区分度。
结果
本研究共纳入 309 例 CKD 患者，其中 G3a 期 80 例，G3b 期 98 例，G4 期 131 例。141 例患者合并糖尿病，168 例患者不合并糖尿病。患者的平均年龄为 57.86±15.10 岁，67%为男性。中位随访时间为 25.6 个月。在整个 CKD 队列中，81 例（26.2%）患者开始透析，其中 CKD 合并糖尿病组 52 例（36.9%），CKD 不合并糖尿病组 29 例（17.3%）。低白蛋白血症（ =2.655， < 0.001）、蛋白尿（ =2.592， = 0.042）、升高的 LDL（ =2.494， < 0.001）、糖尿病（ =2.759， < 0.001）、高血压（ =3.471， = 0.037）和 CKD 分期（ =2.001， = 0.046）是总体人群中 CKD 进展为 ESRD 的危险因素。对于不合并糖尿病的患者，只有低白蛋白血症（ =2.938， = 0.030）是 CKD 进展为 ESRD 的危险因素。对于合并糖尿病的患者，低白蛋白血症（ =2.758， = 0.002）、升高的 LDL（ =3.982， < 0.001）和 CKD 分期（ =3.781， = 0.001）是 CKD 进展为 ESRD 的危险因素。最终列线图的 C-index 为 0.760（ < 0.001）。
结论
我们的危险因素模型结果表明，CKD 疾病进展可以预测，对 CKD 患者进行早期策略性干预对于避免肾功能恶化是必要的。
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