Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Epidemiol. 2023 Dec 25;52(6):1959-1967. doi: 10.1093/ije/dyad111.
We aimed to identify patterns within the rate of kidney function decline, determinants of these patterns and their association with all-cause mortality risk in the general population.
Participants aged ≥ 45 years with at least one assessment of creatinine-based estimated glomerular filtration rate (eGFR) taken between 1997 and 2018 were selected from a population-based cohort study. Analyses were performed using several distinct latent class trajectory modelling methods. Cumulative incidences were calculated with 45 years of age as the starting point.
In 12 062 participants (85 922 eGFR assessments, mean age 67.0 years, 58.7% women, median follow-up 9.6 years), four trajectories of eGFR change with age were identified: slow eGFR decline [rate of change in mL/min/1.73 m2 per year (RC), -0.9; 95% CI, -0.9 to -0.9; reference group], intermediate eGFR decline (RC, -2.5; 95% CI, -2.7 to -2.5) and fast eGFR decline (RC, -4.3; 95% CI, -4.4 to -4.1), and an increase/stable eGFR (RC, 0.3; 95% CI, 0.3 to 0.4). Women were more likely to have an increase/stable eGFR [odds ratio (OR), 1.94; 95% CI, 1.53 to 2.46] whereas men were more likely to have a fast eGFR decline (OR, 1.86; 95% CI, 1.33 to 2.60). Participants with diabetes, cardiovascular disease (CVD) or hypertension were more likely to have an intermediate or fast eGFR decline. All-cause mortality risks (cumulative incidence at age of 70 years) were 32.3% (95% CI, 21.4 to 47.9, slow eGFR decline), 6.7% (95% CI, 3.5 to 12.4, intermediate eGFR decline), 68.8% (95% CI, 44.4 to 87.8, fast eGFR decline) and 9.5% (95% CI, 5.5 to 15.7, increase/stable eGFR).
Sex, hypertension, diabetes and CVD were identified as trajectory membership determinants. Having fast eGFR decline was associated with the highest risk of all-cause mortality, highlighting the need for extensive monitoring and prevention of kidney function decline in individuals at risk of having fast eGFR decline.
本研究旨在明确肾功能下降速率的模式、这些模式的决定因素及其与普通人群全因死亡率风险的关联。
我们从一项基于人群的队列研究中选择了年龄≥45 岁且至少有一次 1997 年至 2018 年之间进行的基于肌酐的估算肾小球滤过率（eGFR）评估的参与者。使用几种不同的潜在类别轨迹建模方法进行分析。以 45 岁为起点计算累积发生率。
在 12062 名参与者（85922 次 eGFR 评估，平均年龄 67.0 岁，58.7%为女性，中位随访时间 9.6 年）中，确定了 4 种肾功能随年龄变化的轨迹：肾功能缓慢下降[mL/min/1.73 m2 年变化率（RC），-0.9；95%置信区间，-0.9 至-0.9；参考组]、肾功能中度下降（RC，-2.5；95%置信区间，-2.7 至-2.5）和肾功能快速下降（RC，-4.3；95%置信区间，-4.4 至-4.1）以及 eGFR 增加/稳定[RC，0.3；95%置信区间，0.3 至 0.4]。女性更有可能出现 eGFR 增加/稳定[优势比（OR），1.94；95%置信区间，1.53 至 2.46]，而男性更有可能出现肾功能快速下降（OR，1.86；95%置信区间，1.33 至 2.60）。患有糖尿病、心血管疾病（CVD）或高血压的参与者更有可能出现肾功能中度或快速下降。全因死亡率风险（70 岁时的累积发生率）分别为 32.3%（95%置信区间，21.4%至 47.9%，肾功能缓慢下降）、6.7%（95%置信区间，3.5%至 12.4%，肾功能中度下降）、68.8%（95%置信区间，44.4%至 87.8%，肾功能快速下降）和 9.5%（95%置信区间，5.5%至 15.7%，eGFR 增加/稳定）。
性别、高血压、糖尿病和 CVD 被确定为轨迹成员决定因素。肾功能快速下降与全因死亡率风险最高相关，这突显了在有发生肾功能快速下降风险的个体中，需要进行广泛的监测和预防肾功能下降。
