Department of Cardiology, The First Affiliated Hospital Sun Yat-Sen University Guangzhou China.
Key Laboratory on Assisted Circulation Ministry of Health Guangzhou China.
J Am Heart Assoc. 2023 Apr 18;12(8):e028556. doi: 10.1161/JAHA.122.028556. Epub 2023 Apr 12.
Background The longitudinal trajectories of renal function have been associated with cardiovascular events in patients with chronic kidney disease (CKD). However, the change pattern of renal function in those without CKD has not yet been reported. We aim to explore patterns of renal function change in a non-CKD population and its associated risks with cardiovascular outcomes. Methods and Results The present study analyzed data from 4 prospective cohorts and was restricted to participants without baseline CKD. The primary outcome was major adverse cardiovascular events, defined as a composite of myocardial infarction, chronic heart failure, stroke, and cardiovascular deaths. We used a group-based trajectory model to identify latent groups and analyzed the associated risk with Cox regression models. The complete dates of this study were June 1, 2020, through January 1, 2021. The final sample comprised 23 760 participants (mean age, 58.63 [9.12] years, 10 618 men, and 17 799 White participants). During 20.56 years follow-up, 8328 (35.05%) first major adverse cardiovascular events happened. Four trajectories in estimated glomerular renal function and 3 patterns of CKD progression were identified. Compared with subjects assigned to class I trajectory (high to mildly decreased group), the adjusted hazard ratios of major adverse cardiovascular events for class II (normal to mildly decreased group), class III (normal to moderately decreased group), and class IV (mildly to severely decreased group) were 1.11 (95% CI, 1.01-1.23), 1.27 (95% CI, 1.14-1.40), and 1.56 (95% CI, 1.38-1.77), respectively. Likewise, participants assigned to the slow and rapid progression groups had elevated HRs for major adverse cardiovascular events (1.75 [95% CI, 1.39-2.21] and 2.19 [95% CI, 1.68-2.86], respectively) when compared with the stable group. Findings were generally consistent in stratification analysis, but significant interaction effects by age and smoking status were detected. Conclusions In this study, we identified unique trajectory groups for renal function. These findings may signal an underlying high-risk population and inspire future studies on individualized risk management.
慢性肾脏病（CKD）患者的肾功能纵向轨迹与心血管事件相关。然而，尚无研究报道非 CKD 患者肾功能变化的模式。本研究旨在探讨非 CKD 人群肾功能变化的模式及其与心血管结局的相关风险。
本研究分析了 4 项前瞻性队列研究的数据，仅限于基线时无 CKD 的参与者。主要结局为主要不良心血管事件，定义为心肌梗死、慢性心力衰竭、卒中和心血管死亡的复合事件。我们使用基于群组的轨迹模型来识别潜在群组，并使用 Cox 回归模型分析相关风险。本研究的完整数据截止日期为 2020 年 6 月 1 日至 2021 年 1 月 1 日。最终样本包括 23760 名参与者（平均年龄 58.63[9.12]岁，10618 名男性，17799 名白种人）。在 20.56 年的随访期间，8328 名（35.05%）患者发生了首次主要不良心血管事件。确定了估计肾小球滤过率的 4 条轨迹和 3 种 CKD 进展模式。与被分配到 I 类轨迹（高到轻度下降组）的患者相比，被分配到 II 类（正常到轻度下降组）、III 类（正常到中度下降组）和 IV 类（轻度到重度下降组）的患者发生主要不良心血管事件的调整后危险比分别为 1.11（95%CI，1.01-1.23）、1.27（95%CI，1.14-1.40）和 1.56（95%CI，1.38-1.77）。同样，与稳定组相比，被分配到缓慢和快速进展组的患者发生主要不良心血管事件的 HR 也升高（1.75[95%CI，1.39-2.21]和 2.19[95%CI，1.68-2.86]）。分层分析结果基本一致，但检测到年龄和吸烟状态的显著交互效应。
在本研究中，我们确定了肾功能的独特轨迹组。这些发现可能预示着存在一个高危人群，并为未来的个体化风险管理研究提供了启示。
