The most important prognostic factors for predicting major adverse cardiovascular, cerebrovascular, and renal events during 5-year follow-up of patients with chronic kidney disease with or without haemodialysis.

IF 1.3 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Nuclear Medicine Communications Pub Date : 2025-03-01 Epub Date: 2025-01-10 DOI:10.1097/MNM.0000000000001943

Takuji Toyama, Shu Kasama, Makito Sato, Hirokazu Sano, Tetsuya Ueda, Toyoshi Sasaki, Takehiro Nakahara, Tetsuya Higuchi, Yoshito Tsushima, Masahiko Kurabayashi

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引用次数: 0

Abstract

Objective: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. The purpose of this study is to evaluate the prognostic predictors over 5 years in patients with CKD including haemodialysis.

Methods: In this multicenter, prospective cohort study performed with the Gunma-CKD SPECT Study protocol, 311 patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml/1.73 m 2 ], including 50 patients on haemodialysis, undergoing stress Tc-99m-tetrofosmin SPECT for suspected ischaemic heart disease were followed for 5 years. MACCRE was evaluated, and summed stress score, summed rest score, summed difference score (SDS), left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were evaluated by electrocardiogram-gated SPECT.

Results: Of the 311 patients, 268 were followed for 5 years, and of those patients, 126 experienced MACCRE: cardiac death, n = 15; sudden death, n = 5, nonfatal myocardial infarction, n = 5; hospitalization for heart failure, n = 16; cerebrovascular accident, n = 9; revascularization, n = 49; renal events (haemodialysis initiation/kidney transplantation), n = 20 and other cardiovascular events, n = 7. In univariate Cox analysis, eGFR ( P < 0.0001), haemoglobin ( P = 0.001), SDS ( P = 0.0001), LVEDV ( P = 0.002), LVESV ( P = 0.0003) and LVEF ( P < 0.0001) were associated with MACCRE, and in multivariate Cox analysis, eGFR ( P = 0.014) and SDS ( P = 0.002) were strongly associated with MACCRE. In Kaplan-Meier analysis, the event-free survival rate for MACCRE was better in patients with SDS below 3 than in those with SDS of 3 or higher ( P < 0.0001, log-rank test) and in patients with eGFR of 18 or higher than in those with eGFR below 18 ( P < 0.0001, log-rank test).

Conclusion: In patients with CKD, SDS and eGFR are reliable prognostic markers for the occurrence of MACCRE over 5 years.

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在有或没有血液透析的慢性肾脏疾病患者的5年随访期间预测主要不良心脑血管和肾脏事件的最重要预后因素。

目的：慢性肾脏疾病（CKD）患者发生不良心脑血管事件的风险增加。本研究的目的是评估包括血液透析在内的CKD患者5年以上的预后预测因素。方法：在这项采用Gunma-CKD SPECT研究方案的多中心前瞻性队列研究中，311例CKD患者[估计肾小球滤过率(eGFR) < 60 min/ml/1.73 m2]，包括50例血液透析患者，对疑似缺血性心脏病进行应激tc -99m-四氟辛SPECT随访5年。评估MACCRE评分，并通过心电图门控SPECT评估总应激评分、总休息评分、总差异评分（SDS）、左室舒张末期容积（LVEDV）、收缩末期容积（LVESV）和射血分数（LVEF）。结果：311例患者中，268例随访5年，其中126例发生MACCRE：心源性死亡，n = 15；猝死，n = 5；非致死性心肌梗死，n = 5；因心力衰竭住院，n = 16；脑血管意外，n = 9；血运重建术，n = 49；肾脏事件（血液透析起始/肾移植），n = 20，其他心血管事件，n = 7。单因素Cox分析中，eGFR （P < 0.0001）、血红蛋白（P = 0.001）、SDS （P = 0.0001）、LVEDV （P = 0.002）、LVESV （P = 0.0003）和LVEF （P < 0.0001）与MACCRE相关，多因素Cox分析中，eGFR （P = 0.014）和SDS （P = 0.002）与MACCRE密切相关。Kaplan-Meier分析显示，SDS低于3的患者的MACCRE无事件生存率高于SDS为3或更高的患者（P < 0.0001， log-rank检验），eGFR为18或更高的患者的MACCRE无事件生存率高于eGFR低于18的患者（P < 0.0001， log-rank检验）。结论：在CKD患者中，SDS和eGFR是5年内MACCRE发生的可靠预后指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nuclear Medicine Communications 医学-核医学

CiteScore

2.20

自引率

6.70%

发文量

212

审稿时长

3-8 weeks

期刊介绍： Nuclear Medicine Communications, the official journal of the British Nuclear Medicine Society, is a rapid communications journal covering nuclear medicine and molecular imaging with radionuclides, and the basic supporting sciences. As well as clinical research and commentary, manuscripts describing research on preclinical and basic sciences (radiochemistry, radiopharmacy, radiobiology, radiopharmacology, medical physics, computing and engineering, and technical and nursing professions involved in delivering nuclear medicine services) are welcomed, as the journal is intended to be of interest internationally to all members of the many medical and non-medical disciplines involved in nuclear medicine. In addition to papers reporting original studies, frankly written editorials and topical reviews are a regular feature of the journal.