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不同CKD定义对长期功能和死亡率的影响,基于人口的队列研究
Delal Dalga1,2, Aurélie Huber1,3, Anne Dufey3
1Department of Medicine, Laboratory of Nephrology, University Hospitals of Geneva, Geneva, Switzerland.
Kidney international reports
|February 24, 2025
概括
使用年龄或个性化身体表面积 (i-BSA) 估计的淋巴细胞过率 (eGFR) 值来定义慢性病 (CKD),这项一般人群研究中没有改善快速功能下降或死亡率的预测.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 慢性病 (CKD) 的诊断依赖于估计的膜过率 (eGFR).
- 标准的eGFR值可能不准确地反映不同人群中CKD的患病率和预后.
- 已经提出了使用年龄或个性化身体表面积 (i-BSA) 的替代定义.
研究的目的:
- 为了比较用于定义CKD的不同eGFR值的患病率和预后值.
- 评估标准,i-BSA校正和年龄分层的eGFR值对预测快速功能衰退 (RRFD) 和死亡率的影响.
- 评估年龄或i-BSA调整是否提高CKD分类准确性.
主要方法:
- 对4952名普通人口参与者的长度研究,随访时间长达15年.
- 基于白蛋白尿和/或eGFR<60ml/min/1.73 m2 (标准),<60ml/min以i-BSA进行校正,或年龄分层值的CKD分类.
- 用调整的考克斯回归分析来预测RRFD和死亡率.
主要成果:
- 年龄分层定义重新分类了一些参与者,但没有改变结果.
- 65岁以上的参与者被重新归类为非CKD,出现了不良事件,表明潜在的诊断不足.
- 所有CKD定义都预测了更差的预后 (RRFD和死亡率),危险比率在1.64到2.23之间,无论使用什么定义.
结论:
- 与标准定义相比,当前的年龄或i-BSA调整的eGFR值没有提高RRFD和死亡率的预测.
- 无论如何定义,CKD的诊断都与不良结果的风险增加有关.
- 可能需要进一步的研究来完善CKD诊断标准,以提高预后准确度.
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