Astellas Pharma Europe B.V., Leiden, The Netherlands.
Pricing and Market Access, Santen Pharmaceutical, Alpha Tower, De Entree 11-97, 1101, Amsterdam, The Netherlands.
J Nephrol. 2023 Jul;36(6):1639-1649. doi: 10.1007/s40620-023-01626-8. Epub 2023 Jun 8.
Established cardiovascular risk assessment tools lack chronic kidney disease-specific clinical factors and may underestimate cardiovascular risk in non-dialysis-dependent chronic kidney disease (CKD) patients.
A retrospective analysis of a cohort of patients with stage 3-5 non-dialysis-dependent chronic kidney disease in the Salford Kidney Study (UK, 2002-2016) was performed. Multivariable Cox regression models with backward selection and repeated measures joint models were used to evaluate clinical risk factors associated with cardiovascular events (individual and composite cardiovascular major adverse cardiovascular events), mortality (all-cause and cardiovascular-specific), and need for renal replacement therapy. Models were established using 70% of the cohort and validated on the remaining 30%. Hazard ratios ([95% CIs]) were reported.
Among 2192 patients, mean follow-up was 5.6 years. Cardiovascular major adverse cardiovascular events occurred in 422 (19.3%) patients; predictors included prior history of diabetes (1.39 [1.13-1.71]; P = 0.002) and serum albumin reduction of 5 g/L (1.20 [1.05-1.36]; P = 0.006). All-cause mortality occurred in 740 (33.4%) patients, median time to death was 3.8 years; predictors included reduction of estimated glomerular filtration of 5 mL/min/1.73 m (1.05 [1.01-1.08]; P = 0.011) and increase of phosphate of 0.1 mmol/L (1.04 [1.01-1.08]; P = 0.021), whereas a 10 g/L hemoglobin increase was protective (0.90 [0.85-0.95]; P < 0.001). In 394 (18.0%) patients who received renal replacement therapy, median time to event was 2.3 years; predictors included halving of estimated glomerular filtration rate (3.40 [2.65-4.35]; P < 0.001) and antihypertensive use (1.23 [1.12-1.34]; P < 0.001). Increasing age, albumin reduction, and prior history of diabetes or cardiovascular disease were risk factors for all outcomes except renal replacement therapy.
Several chronic kidney disease-specific cardiovascular risk factors were associated with increased mortality and cardiovascular event risk in patients with non-dialysis-dependent chronic kidney disease.
已有的心血管风险评估工具缺乏慢性肾脏病特有的临床因素，可能会低估非透析依赖型慢性肾脏病（CKD）患者的心血管风险。
对英国索尔福德肾脏研究（2002-2016 年）中 3-5 期非透析依赖型慢性肾脏病患者队列进行回顾性分析。使用多变量 Cox 回归模型进行向后选择和重复测量联合模型，以评估与心血管事件（个体和综合心血管主要不良心血管事件）、死亡率（全因和心血管特异性）和肾脏替代治疗需求相关的临床危险因素。使用队列的 70%建立模型，并用其余 30%进行验证。报告了风险比（[95%CI]）。
在 2192 名患者中，平均随访时间为 5.6 年。422 名（19.3%）患者发生心血管主要不良心血管事件；预测因素包括既往糖尿病史（1.39[1.13-1.71]；P=0.002）和血清白蛋白降低 5g/L（1.20[1.05-1.36]；P=0.006）。740 名（33.4%）患者发生全因死亡，中位死亡时间为 3.8 年；预测因素包括估计肾小球滤过率降低 5mL/min/1.73m（1.05[1.01-1.08]；P=0.011）和磷酸盐升高 0.1mmol/L（1.04[1.01-1.08]；P=0.021），而血红蛋白增加 10g/L 具有保护作用（0.90[0.85-0.95]；P<0.001）。在 394 名接受肾脏替代治疗的患者中，中位事件时间为 2.3 年；预测因素包括估计肾小球滤过率减半（3.40[2.65-4.35]；P<0.001）和使用降压药（1.23[1.12-1.34]；P<0.001）。年龄增长、白蛋白减少以及既往糖尿病或心血管疾病史是除肾脏替代治疗外所有结局的危险因素。
在非透析依赖型慢性肾脏病患者中，一些慢性肾脏病特有的心血管危险因素与死亡率和心血管事件风险增加相关。
