Zhu Fan, Gan Wenyuan, Liu Hui, Chen Wenli, Zeng Xingruo
Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
Int Urol Nephrol. 2025 Mar;57(3):885-895. doi: 10.1007/s11255-024-04227-x. Epub 2024 Oct 14.
Chronic diseases rarely occur in isolation, and chronic kidney disease (CKD) is no exception. There has been considerable research on the interplay between the heart and kidneys, but studies on the relationship between the lungs and kidneys are less common. The interaction between pulmonary and renal functions in areas such as acid-base metabolism, chronic inflammation, and bone metabolism is increasingly gaining clinical attention.
In this cohort study, we examined 480 patients with stages 3-4 CKD and COPD (GOLD stages 1 and 2) to identify risk factors that contribute to the progression of renal function to a composite endpoint, which includes a 40% decline in estimated glomerular filtration rate (eGFR) and the onset of end-stage renal disease during follow-up periods. A Cox proportional hazards regression model was used to investigate the risk factors associated with the timing of renal event endpoints in the study population. Additionally, the restricted cubic spline method was used to explore the relationship between quantitative variables and survival risk.
Our study included 480 eligible patients with an average follow-up period of 21.41 ± 14.90 months, during which 224 individuals (46.7%) experienced the composite renal endpoints. Multivariable Cox regression analysis revealed that systolic blood pressure (SBP) [1.01 (1.00-1.02), p = 0.002], hemoglobin (Hb) [HR 0.89 (0.83-0.96), p = 0.002], albumin (Alb) [0.96 (0.93-0.99), p = 0.009], and edema [1.73 (1.29-2.33), p < 0.001] were independent risk factors for the renal endpoints.
The adjusted multivariable Cox regression analysis demonstrated that elevated SBP and edema were factors that promoted the occurrence of composite endpoints, while higher levels of Hb and Alb were protective factors.
慢性病很少单独发生，慢性肾脏病（CKD）也不例外。关于心脏和肾脏之间相互作用的研究已有很多，但关于肺和肾脏之间关系的研究则较少见。肺和肾功能在酸碱代谢、慢性炎症和骨代谢等方面的相互作用越来越受到临床关注。
在这项队列研究中，我们检查了480例3-4期CKD和慢性阻塞性肺疾病（COPD，全球慢性阻塞性肺疾病倡议分级1和2级）患者，以确定导致肾功能进展至复合终点的危险因素，该复合终点包括随访期间估计肾小球滤过率（eGFR）下降40%和终末期肾病的发生。采用Cox比例风险回归模型研究研究人群中与肾脏事件终点发生时间相关的危险因素。此外，使用受限立方样条法探讨定量变量与生存风险之间的关系。
我们的研究纳入了480例符合条件的患者，平均随访期为21.41±14.90个月，在此期间，224例个体（46.7%）出现了复合肾脏终点。多变量Cox回归分析显示，收缩压（SBP）[1.01（1.00-1.02），p=0.002]、血红蛋白（Hb）[风险比（HR）0.89（0.83-0.96），p=0.002]、白蛋白（Alb）[0.96（0.93-0.99），p=0.009]和水肿[1.73（1.29-2.33），p<0.001]是肾脏终点的独立危险因素。
校正后的多变量Cox回归分析表明，SBP升高和水肿是促进复合终点发生的因素，而较高水平的Hb和Alb是保护因素。
