Clin Kidney J:基于研究的与临床血清肌酐的比较以及急性肾损伤与随后肾功能的关系

2020-03-02 不详 网络

依靠临床获得的数据进行的观察研究表明,急性肾损伤(AKI)与慢性肾脏病(CKD)的进展有关。但是,先前的报道缺乏统一收集重要的混杂因素,例如蛋白尿和AKI之前的肾功能轨迹,并且可能易于确定偏倚,因为患者在AKI后更可能接受肾功能测试。我们研究了444名患有CKD的成人,他们参加了前瞻性慢性肾功能不全队列研究(CRIC),并且是大型综合医疗服务系统的同时成员。根据(i)CRIC研究方案(每年)和(i

依靠临床获得的数据进行的观察研究表明,急性肾损伤(AKI)与慢性肾脏病(CKD)的进展有关。但是,先前的报道缺乏统一收集重要的混杂因素,例如蛋白尿和AKI之前的肾功能轨迹,并且可能易于确定偏倚,因为患者在AKI后更可能接受肾功能测试。

我们研究了444名患有CKD的成人,他们参加了前瞻性慢性肾功能不全队列研究(CRIC),并且是大型综合医疗服务系统的同时成员。根据(i)CRIC研究方案(每年)和(ii)常规临床护理中的血清肌酐测量值估算肾小球滤过率(eGFR)轨迹。使用线性混合效应模型来评估AKI与eGFR和AKI后eGFR斜率变化之间的关联,并探讨这些变化是否随肌酐结果来源而变化。校正模型的人口统计学特征,糖尿病状态和蛋白尿。

结果,在8.5年的中位随访期间,eGFR的平均损失率为-0.31nmL/min/1.73 m2/年,共有73例患者发生了AKI(第1阶段的55%)。AKI与血清肌酐来源之间存在密切相互作用,以引起出院后eGFR水平的改变;相比之下,AKI与eGFR下降速度更快相关(平均额外损失为-0.670.6 mL/min/1.73 m2 /年),这不受血清肌酐来源的影响。

总之,无论使用何种血清肌酐来源,AKI均与随后的eGFR急剧下降相关,但考虑到关键的混杂因素(如AKI之前的eGFR斜率和蛋白尿),其关联强度比以前的研究小。

原始出处:

Raymond K Hsu, Chi-yuan Hsu, et al., Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study. Clin Kidney J. 2020 Feb; 13(1): 55–62. doi: 10.1093/ckj/sfz057

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    2021-02-03 yese
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    2020-03-04 俅侠
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    2020-03-04 zhaojie88