肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价

目的探讨临床上使用广泛的慢性肾脏病流行病学协助组(CKD-EPI)肾小球滤过率(GFR)评估方程、改良肾脏病膳食改良试验(MDRD)方程与近年来针对中国人开发的Feng方程、针对中国糖尿病患者改良的CKD-EPI糖尿病方程在中国糖尿病合并慢性肾脏病(CKD)患者中的适用性,进而为临床中准确估测糖尿病合并CKD患者GFR提供更精确的依据。方法选取2型糖尿病合并CKD患者160名。收集患者性别、年龄、身高、体质量、血肌酐(Scr)及胱抑素C(Cys C)。以99m Tc-DTPA肾动态显像法测定的GFR作为参考GFR(rGFR)。使用中国改良MDRD方程、CKD-EPI Scr方程、CKD-EPI Cys C方程、CKD-EPI Scr-Cys C方程、CKD-EPI糖尿病方程、Feng Cys C方程及Feng Scr-Cys C方程对估算GFR(eGFR)进行计算。采用Pearson相关性分析及κ检验比较各方程eGFR与rGFR之间的相关性及分期一致性,并使用Bland-Altman分析法比较各方程eGFR与rGFR的一致性限度。各方程eGFR之间的比较使用偏倚、精确度、10%准确率、30%准确率、50%准确率。定义GFR<60 mL min^-1 (1.73 m^2)^-1为肾功能不全的诊断标准,通过ROC曲线比较各方程诊断肾功能不全的效能。根据rGFR将患者分为A组(CKD 4~5期)、B组(CKD 3期)、C组(CKD 1~2期),比较不同分组中各方程的适用性。结果在各方程eGFR之间的比较中,CKD-EPI糖尿病方程偏倚最小,与Feng Cys C方程、Feng Scr-Cys C方程比较差异有统计学意义(P<0.05);精确度最高,与改良MDRD方程、CKD-EPI Cys C方程比较差异有统计学意义(P<0.05)。在7种方程的准确率比较中,CKD-EPI糖尿病方程10%、30%准确率均最高,与简化MDRD方程、CKD-EPI Scr方程、CKD-EPI Cys C方程比较差异均有统计学意义(P<0.05)。Bland-Altman分析显示CKD-EPI糖尿病方程一致性限度最佳。在A组患者中,CKD-EPI Cys C方程eGFR与rGFR均值比较差异无统计学意义,偏倚最小,50%、30%准确率最高。B组患者与总体患者类似,CKD-EPI糖尿病方程偏倚最小,精确度最高,10%、30%、50%准确率均最高。结论在7种方程的比较中,CKD-EPI糖尿病方程eGFR与rGFR拟合度最佳。在不同分组的比较中,CKD 4~5期患者CKD-EPI Cys C方程eGFR与rGFR拟合度最佳,CKD 3期患者CKD-EPI糖尿病方程eGFR与rGFR拟合度最佳,可分别用于估测糖尿病合并CKD不同分组患者的GFR。

Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients

Background Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease （CKD） patients are limited.The aim of the present study was to investigate the prevalence,awareness,treatment,and control of hypertension in the non-dialysis CKD patients through a nationwide,multicenter study in China.Methods The survey was performed in 61 tertiary hospitals in 31 provinces,municipalities,and autonomous regions in China （except Hong Kong,Macao,and Taiwan）.Trained physicians collected demographic and clinical data and measured blood pressure （BP） using a standardized protocol.Hypertension was defned as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg,and/or use of antihypertensive medications.BP 〈140/90 mmHg and 〈130/80 mmHg were used as the 2 thresholds of hypertension control.In multivariate logistic regression with adjustment for sex and age,we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.Results The analysis included 8927 non-dialysis CKD patients.The prevalence,awareness,and treatment of hypertension in non-dialysis CKD patients were 67.3%,85.8%,and 81.0%,respectively.Of hypertensive CKD patients,33.1% and 14.1% had controlled BP to 〈140/90 mmHg and 〈130/80 mmHg,respectively.With successive CKD stages,the prevalence of hypertension in non-dialysis CKD patients increased,but the control of hypertension decreased （P〈0.001）.When the threshold of BP 〈130/80 mmHg was considered,the risk of uncontrolled hypertension in CKD 2,3a,3b,4,and 5 stages increased 1.3,1.4,1.4,2.5,and 4.0 times compared with CKD 1 stage,respectively （P〈0.05）.Using the threshold of 〈140/90 mmHg,the risk of uncontrolled hypertension increased in advanced stages （P〈0.05）.Conclusions The prevalence of hypertension Chinese non-dialysis CKD patients was high,and the hypertension control was suboptimal.With successive CKD stages,the risk of uncontrolled hypertension increased.