Maruyama Shoichi, Tanaka Tetsuhiro, Akiyama Hiroki, Hoshino Mitsuru, Inokuchi Shoichiro, Kaneko Shuji, Shimamoto Koji, Ozaki Asuka
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Nephrology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clin Kidney J. 2024 Jul 30;17(8):sfae228. doi: 10.1093/ckj/sfae228. eCollection 2024 Aug.
This study aimed to assess the prognosis of people with chronic kidney disease (CKD) in Japan using the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap.
The prognoses of individuals with estimated glomerular filtration rates (eGFR) <90 mL/min/1.73 m were evaluated based on the KDIGO heatmap using an electronic medical record database in Japan. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction (MI), stroke, heart failure (HF) hospitalization and in-hospital death (referred to as MACE1). Additionally, MACE2 (MI hospitalization, stroke hospitalization, HF hospitalization and in-hospital death) was examined. The secondary outcome was the renal outcome.
Of the 543 606 individuals included, the mean age was 61.6 ± 15.3 years, 50.1% were male and 40.9% lacked urine protein results. The risk of MACEs increased independently with both eGFR decline and increasing proteinuria from the early KDIGO stages: hazard ratios (95% confidence interval) of MACE1 and MACE2, compared with G2A1 were 1.16 (1.12-1.20) and 1.17 (1.11-1.23), respectively, for G3aA1, and 1.17 (1.12-1.21) and 1.35 (1.28-1.43), respectively, for G2A2. This increased up to 2.83 (2.54-3.15) and 3.43 (3.00-3.93), respectively, for G5A3. Risks of renal outcomes also increased with CKD progression.
This study is the first to demonstrate the applicability of the KDIGO heatmap in assessing cardiovascular and renal risk in Japan. The risk increased from the early stages of CKD, indicating the importance of early diagnosis and intervention through appropriate testing.
本研究旨在使用改善全球肾脏病预后（KDIGO）热图评估日本慢性肾脏病（CKD）患者的预后。
在日本，利用电子病历数据库，基于KDIGO热图对估算肾小球滤过率（eGFR）<90 mL/min/1.73 m²的个体的预后进行评估。主要结局是主要不良心血管事件（MACE），它是心肌梗死（MI）、中风、心力衰竭（HF）住院和院内死亡的复合事件（称为MACE1）。此外，还对MACE2（MI住院、中风住院、HF住院和院内死亡）进行了检查。次要结局是肾脏结局。
纳入的543606名个体中，平均年龄为61.6±15.3岁，50.1%为男性，40.9%缺乏尿蛋白结果。从KDIGO早期阶段开始，MACE的风险随eGFR下降和蛋白尿增加而独立升高：与G2A1相比，G3aA1的MACE1和MACE2的风险比（95%置信区间）分别为1.16（1.12 - 1.20）和1.17（1.11 - 1.23），G2A2的分别为1.17（1.12 - 1.21）和1.35（1.28 - 1.43）。到G5A3时，分别增至2.83（2.54 - 3.15）和3.43（3.00 - 3.93）。肾脏结局的风险也随CKD进展而增加。
本研究首次证明了KDIGO热图在评估日本心血管和肾脏风险方面的适用性。风险从CKD早期阶段就开始增加，这表明通过适当检测进行早期诊断和干预的重要性。
