Kitamura Hiromasa, Tanaka Shigeru, Hiyamuta Hiroto, Tsuruya Kazuhiko, Kitazono Takanari, Nakano Toshiaki
Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Nephrol. 2025;56(3):366-376. doi: 10.1159/000543201. Epub 2025 Jan 8.
The Kidney Disease: Improving Global Outcomes guidelines recognize the importance of causes of chronic kidney disease (CKD), glomerular filtration rate, and albuminuria as predictors of kidney outcome and prognosis. However, compared with biopsy-proven causes, there has been limited research regarding the relationship between clinically diagnosed causes of CKD and patient prognosis.
We examined 3,119 patients with non-dialysis-dependent CKD who participated in the Fukuoka Kidney disease Registry Study, a multicenter prospective cohort study. Patients were divided into six groups: IgA nephropathy, chronic glomerulonephritis (non-biopsy-proven), diabetic nephropathy, hypertensive nephrosclerosis, chronic interstitial nephritis, and polycystic kidney disease. The primary outcomes included a composite kidney outcome, defined as a 1.5-fold increase in serum creatinine and/or the development of end-stage kidney disease, and all-cause mortality. The risks of these outcomes were estimated using a Fine-Gray proportional subdistribution hazards model. Patients with IgA nephropathy, the most prevalent primary glomerulonephritis, served as the reference group.
During the median follow-up period of 5 years, 1,221 patients developed the composite kidney outcome, and 346 patients died. Compared with IgA nephropathy, the multivariable-adjusted subdistribution hazard ratios (sHRs) for the composite kidney outcome were significantly higher in diabetic nephropathy (sHR 1.45) and polycystic kidney disease (sHR 2.07) groups, whereas the chronic interstitial nephritis group had a significantly lower risk (sHR 0.71). The risk of all-cause mortality was significantly higher in the hypertensive nephrosclerosis group (sHR 1.90).
The causes of CKD were associated with risks of the composite kidney outcome and all-cause mortality, highlighting their clinical relevance in predicting prognosis. These findings suggest that different causes of CKD have distinct impacts on patient outcomes, emphasizing the importance of tailoring management strategies according to the underlying causes.
《改善全球肾脏病预后》指南认识到慢性肾脏病（CKD）的病因、肾小球滤过率和蛋白尿作为肾脏结局及预后预测指标的重要性。然而，与经活检证实的病因相比，关于临床诊断的CKD病因与患者预后之间关系的研究有限。
我们研究了3119例非透析依赖型CKD患者，这些患者参与了一项多中心前瞻性队列研究——福冈肾脏病登记研究。患者被分为六组：IgA肾病、慢性肾小球肾炎（未经活检证实）、糖尿病肾病、高血压肾硬化症、慢性间质性肾炎和多囊肾病。主要结局包括复合肾脏结局，定义为血清肌酐升高1.5倍和/或终末期肾病的发生，以及全因死亡率。使用Fine-Gray比例子分布风险模型估计这些结局的风险。IgA肾病是最常见的原发性肾小球肾炎，以其患者作为参照组。
在5年的中位随访期内，1221例患者出现了复合肾脏结局，346例患者死亡。与IgA肾病相比，糖尿病肾病组（风险比1.45）和多囊肾病组（风险比2.07）出现复合肾脏结局的多变量调整子分布风险比显著更高，而慢性间质性肾炎组的风险则显著更低（风险比0.71）。高血压肾硬化症组的全因死亡率风险显著更高（风险比1.90）。
CKD的病因与复合肾脏结局及全因死亡率风险相关，突出了它们在预测预后方面的临床相关性。这些发现表明，不同的CKD病因对患者结局有不同影响，强调了根据潜在病因制定管理策略的重要性。
