Querfeld Uwe, Kirchner Marietta, Mencarelli Francesca, Azukaitis Karolis, Bayazit Aysun, Duzova Ali, Doyon Anke, Canpolat Nur, Bulut Ipek Kaplan, Obrycki Lukasz, Bacchetta Justine, Shroff Rukshana, Paripovic Dusan, Candan Cengiz, Harambat Jerome, Yilmaz Alev, Alpay Harika, Oh Jun, Erdogan Hakan, Schmitt Claus P, Melk Anette, Schaefer Franz
Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité University Hospital, Berlin, Germany.
Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Kidney Int Rep. 2025 Feb 17;10(5):1393-1403. doi: 10.1016/j.ekir.2025.02.007. eCollection 2025 May.
There are discrepant findings regarding the effect of dyslipidemia on disease progression in adult patients with chronic kidney disease (CKD).
In a prospective cohort study of children with stage 3 to 5 (predialysis) CKD, triglycerides (TGs), total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured semiannually. We investigated whether CKD progression is associated with serum lipid levels at baseline and with lipid trajectories during follow-up. CKD progression was defined as the time to a composite event of 50% reduction in estimated glomerular filtration rate (eGFR), eGFR < 10 ml/min per 1.73 m, or start of kidney replacement therapy. By semiparametric group-based trajectory modeling (GBTM), 2 trajectories were defined for each lipid, termed "high" and "low."
A total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min per 1.73 m were included. Kidney diagnosis was classified as congenital anomalies of the kidneys and urinary tracts (CAKUT) in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. During a median of 5.1 years of follow-up, 59% of patients reached the composite end point. Kidney survival was significantly different for HDL-C ( = 0.0128), but not for other lipid trajectories in the Kaplan-Meier analysis. There was no significant association of any of the lipid trajectories with CKD progression in Cox proportional hazard models. Variables consistently associated with CKD progression in models for each lipid at baseline and for lipid trajectories included age, a diagnosis other than CAKUT, eGFR at baseline, albuminuria, the serum albumin level, and diastolic blood pressure (BP).
These data do not support an important role for lipids in the progression of CKD in children.
关于血脂异常对成年慢性肾脏病（CKD）患者疾病进展的影响，存在相互矛盾的研究结果。
在一项对3至5期（透析前）CKD儿童的前瞻性队列研究中，每半年测量一次甘油三酯（TGs）、总胆固醇（CHOL）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）。我们研究了CKD进展是否与基线时的血清脂质水平以及随访期间的脂质轨迹相关。CKD进展定义为达到以下复合事件的时间：估计肾小球滤过率（eGFR）降低50%、eGFR<10 ml/min/1.73 m²或开始肾脏替代治疗。通过基于半参数分组的轨迹模型（GBTM），为每种脂质定义了2条轨迹，分别称为“高”和“低”。
共纳入681例年龄为12.2±3.3岁、平均eGFR为26.9±11.6 ml/min/1.73 m²的患者。肾脏诊断分类为：69%的患者为先天性肾脏和尿路异常（CAKUT），8.4%为肾小球病，22.6%为其他疾病。在中位随访5.1年期间，59%的患者达到复合终点。在Kaplan-Meier分析中，HDL-C的肾脏生存率有显著差异（P = 0.0128），但其他脂质轨迹无显著差异。在Cox比例风险模型中，任何脂质轨迹与CKD进展均无显著关联。在每种脂质的基线模型和脂质轨迹模型中，与CKD进展始终相关的变量包括年龄、非CAKUT诊断、基线时的eGFR、蛋白尿、血清白蛋白水平和舒张压（BP）。
这些数据不支持脂质在儿童CKD进展中起重要作用。
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