蛋白尿轨迹与CKD患者肾功能衰竭和死亡的关系

IF 3.2 Q1 UROLOGY & NEPHROLOGY
Kidney360 Pub Date : 2025-06-26 DOI:10.34067/KID.0000000849
Avi G Aronov, Ashish Verma, Ana C Ricardo, Tanika N Kelly, Sushrut S Waikar, James P Lash, Anand Srivastava
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引用次数: 0

摘要

背景:尽管在CKD患者的临床过程中多次重复蛋白尿测量,但临床医生可能会忽视蛋白尿时间模式的重要性。此外,目前尚不清楚蛋白尿轨迹是否确定具有不同不良临床结果风险的亚人群。方法:我们使用基于组的轨迹模型,根据3209名慢性肾功能不全队列研究参与者的年度尿蛋白与肌酐比值(UPCR)测量来确定蛋白尿轨迹,这些参与者在研究开始的3年内没有患上终末期肾病(ESKD)。多变量调整的Cox比例风险模型检验了UPCR轨迹与ESKD和第三次年度就诊后存活患者死亡的关系。结果:轨迹分析根据年度UPCR测量确定了4个离散组:低缓慢上升(n=1528),高缓慢上升(n=1363),回归(n=114)和快速上升(n=204)。与低-慢上升蛋白尿轨迹组相比,其他蛋白尿轨迹组的参与者社会经济地位较低,合并症患病率较高,eGFR较低。在8.6年的中位随访期间,547名参与者进展为ESKD, 836名参与者死亡。与低-慢上升组相比,所有蛋白尿轨迹组均与后续ESKD的高风险相关,但只有高-慢上升组与更高的死亡风险相关。结论:重复蛋白尿测量的轨迹确定了CKD患者的亚组,这些亚组具有ESKD和死亡风险增加,独立于已知的危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associations of Proteinuria Trajectories with Kidney Failure and Death in Individuals with CKD.

Background: Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify sub-populations with varying risks of adverse clinical outcomes.

Methods: We used group-based trajectory modeling to identify proteinuria trajectories based on annual urine protein-to-creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort Study who were alive and did not reach end-stage kidney disease (ESKD) within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the 3rd annual visit.

Results: Trajectory analyses identified 4 discrete groups based on annual UPCR measurements: low-slowly rising (n=1528), high-slowly rising (n=1363), regressing (n=114), and rapidly rising (n=204). Compared to the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared to the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.

Conclusions: Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.

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来源期刊
Kidney360
Kidney360 UROLOGY & NEPHROLOGY-
CiteScore
3.90
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