Tsao Hsiao-Mei, Lai Tai-Shuan, Chou Yu-Hsiang, Lin Shuei-Liong, Chen Yung-Ming
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ther Adv Chronic Dis. 2023 Jun 6;14:20406223231177291. doi: 10.1177/20406223231177291. eCollection 2023.
The glomerular filtration rate (GFR) decline varies in patients with advanced chronic kidney disease (CKD), and the concurrent changes in CKD-related biomarkers are unclear.
This study aimed to examine the changes in CKD-related biomarkers along with the kidney function decline in various GFR trajectory groups.
This study was a longitudinal cohort study originated from the pre-end-stage renal disease (pre-ESRD) care program in a single tertiary center between 2006 and 2019.
We adopted a group-based trajectory model to categorize CKD patients into three trajectories according to estimated glomerular filtration rate (eGFR) changes. A repeated-measures linear mixed model was used to estimate the concurrent biomarker trends in a 2-year period before dialysis and to examine the differences among trajectory groups. A total of 15 biomarkers were analyzed, including urine protein, serum uric acid, albumin, lipid, electrolytes, and hematologic markers.
Using longitudinal data from 2 years before dialysis initiation, 1758 CKD patients were included. We identified three distinct eGFR trajectories: persistently low eGFR levels, progressive loss of eGFR, and accelerated loss of eGFR. Eight of the 15 biomarkers showed distinct patterns among the trajectory groups. Compared with the group with persistently low eGFR values, the other two groups were associated with a more rapid increase in the blood urea nitrogen (BUN) level and urine protein-creatinine ratio (UPCR), especially in the year before dialysis initiation, and a more rapid decline in hemoglobin and platelet counts. A rapid eGFR decline was associated with lower levels of albumin and potassium, and higher levels of mean corpuscular hemoglobin concentration (MCHC) and white blood cell (WBC). The albumin level in the group with an accelerated loss of eGFR was below the normal range.
Using longitudinal data, we delineated the changes in CKD biomarkers with disease progression. The results provide information to clinicians and clues to elucidate the mechanism of CKD progression.
晚期慢性肾脏病（CKD）患者的肾小球滤过率（GFR）下降情况各不相同，而CKD相关生物标志物的同时变化尚不清楚。
本研究旨在探讨不同GFR轨迹组中CKD相关生物标志物随肾功能下降的变化情况。
本研究是一项纵向队列研究，源自2006年至2019年期间一家三级中心的终末期肾病前期（pre-ESRD）护理项目。
我们采用基于组的轨迹模型，根据估计肾小球滤过率（eGFR）变化将CKD患者分为三种轨迹。使用重复测量线性混合模型来估计透析前2年期间生物标志物的同时变化趋势，并检验轨迹组之间的差异。共分析了15种生物标志物，包括尿蛋白、血清尿酸、白蛋白、脂质、电解质和血液学指标。
利用透析开始前2年的纵向数据，纳入了1758例CKD患者。我们确定了三种不同的eGFR轨迹：持续低eGFR水平、eGFR逐渐丧失和eGFR加速丧失。15种生物标志物中的8种在轨迹组间呈现出不同模式。与持续低eGFR值组相比，其他两组的血尿素氮（BUN）水平和尿蛋白肌酐比值（UPCR）升高更快，尤其是在透析开始前一年，血红蛋白和血小板计数下降更快。eGFR快速下降与较低的白蛋白和钾水平以及较高的平均红细胞血红蛋白浓度（MCHC）和白细胞（WBC）水平相关。eGFR加速丧失组的白蛋白水平低于正常范围。
利用纵向数据，我们描绘了CKD生物标志物随疾病进展的变化情况。研究结果为临床医生提供了信息，并为阐明CKD进展机制提供了线索。
