缺血性肾病-慢性肾脏病（ISCHEMIA-CKD）试验中晚期慢性肾脏病患者的病因特异性死亡率。
Cause-Specific Mortality in Patients With Advanced Chronic Kidney Disease in the ISCHEMIA-CKD Trial.
机构信息
Albany Medical College, Albany, New York, USA.
Duke Clinical Research Institute and Duke University, Durham, North Carolina, USA.
出版信息
JACC Cardiovasc Interv. 2023 Jan 23;16(2):209-218. doi: 10.1016/j.jcin.2022.10.062.
BACKGROUND
In ISCHEMIA-CKD, 777 patients with advanced chronic kidney disease and chronic coronary disease had similar all-cause mortality with either an initial invasive or conservative strategy (27.2% vs 27.8%, respectively).
OBJECTIVES
This prespecified secondary analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) was conducted to determine whether an initial invasive strategy compared with a conservative strategy decreased the incidence of cardiovascular (CV) vs non-CV causes of death.
METHODS
Three-year cumulative incidences were calculated for the adjudicated cause of death. Overall and cause-specific death by treatment strategy were analyzed using Cox models adjusted for baseline covariates. The association between cause of death, risk factors, and treatment strategy were identified.
RESULTS
A total of 192 of the 777 participants died during follow-up, including 94 (12.1%) of a CV cause, 59 (7.6%) of a non-CV cause, and 39 (5.0%) of an undetermined cause. The 3-year cumulative rates of CV death were similar between the invasive and conservative strategies (14.6% vs 12.6%, respectively; HR: 1.13, 95% CI: 0.75-1.70). Non-CV death rates were also similar between the invasive and conservative arms (8.4% and 8.2%, respectively; HR: 1.25; 95% CI: 0.75-2.09). Sudden cardiac death (46.8% of CV deaths) and infection (54.2% of non-CV deaths) were the most common cause-specific deaths and did not vary by treatment strategy.
CONCLUSIONS
In ISCHEMIA-CKD, CV death was more common than non-CV or undetermined death during the 3-year follow-up. The randomized treatment assignment did not affect the cause-specific incidences of death in participants with advanced CKD and moderate or severe myocardial ischemia. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease [ISCHEMIA-CKD]; NCT01985360).
背景
在 ISCHEMIA-CKD 研究中，777 例患有晚期慢性肾脏病和慢性冠状动脉疾病的患者，采用初始侵入性策略或保守策略的全因死亡率相似（分别为 27.2%和 27.8%）。
目的
本研究为 ISCHEMIA-CKD 研究的预设二次分析，旨在确定与保守策略相比，初始侵入性策略是否会降低心血管（CV）与非 CV 原因导致的死亡发生率。
方法
根据死亡原因进行了 3 年累积发生率的计算。采用 Cox 模型分析了治疗策略与全因死亡和死因特异性死亡的相关性，模型校正了基线协变量。确定了死亡原因、危险因素与治疗策略之间的关联。
结果
在随访期间，共有 777 例患者中的 192 例死亡，包括 94 例（12.1%）CV 原因死亡、59 例（7.6%）非 CV 原因死亡和 39 例（5.0%）原因不明的死亡。侵入性策略和保守策略的 3 年 CV 死亡累积发生率相似（分别为 14.6%和 12.6%，HR：1.13，95%CI：0.75-1.70）。侵入性策略组和保守策略组的非 CV 死亡率也相似（分别为 8.4%和 8.2%，HR：1.25，95%CI：0.75-2.09）。心源性猝死（CV 死亡的 46.8%）和感染（非 CV 死亡的 54.2%）是最常见的死因，与治疗策略无关。
结论
在 ISCHEMIA-CKD 研究中，在 3 年的随访期间，CV 死亡比非 CV 或原因不明的死亡更为常见。随机治疗分配并未影响晚期慢性肾脏病和中度或重度心肌缺血患者的死因特异性死亡率。（国际比较医疗与侵入性治疗慢性肾脏病效果研究[ISCHEMIA-CKD]；NCT01985360）。
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