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Estimated glomerular filtration rate and risk of all-cause mortality
Journal of Diabetes ( IF 4.5 ) Pub Date : 2023-12-04 , DOI: 10.1111/1753-0407.13513
Tomoyuki Kawada 1
Affiliation  

Liu et al.1 conducted a prospective study to examine the associations between several estimated glomerular filtration rates (eGFRs) and all-cause mortality with special reference to diabetes status. The mean age of the subjects was about 60 years, and eGFR measure was classified into three groups: normal, modestly declined, and chronic kidney disease (CKD). The adjusted hazard ratio (HR) of CKD defined by eGFRs with cystatin C and a combination with cystatin C and creatinine for all-cause mortality significantly increased among patients with diabetes. In contrast, the adjusted HR of modestly declined eGFR and CKD with use of any estimated equations for all-cause mortality significantly increased. I have some concerns about their study.

First, Hussain et al.2 investigated age-specific associations of eGFR with adverse outcomes. By setting age-specific eGFR reference as a control, the adjusted HR (95% CI) of modest reduction in eGFRs for composite adverse outcome (all-cause mortality, any cardiovascular event, and kidney failure) in subjects aged 18–39, 40–49, and 50–65 were 1.42 (1.35–1.49), 1.13 (1.10–1.16), and 1.08 (1.07–1.09), respectively. Although the absolute risk in the incidence of composite adverse outcome in subjects with mild reduction of eGFR increased by aging, special attention should be paid to the younger generation for composite adverse outcome. They used serum creatinine for estimating eGFR, and I suppose that additional analyses by using cystatin C and a combination with cystatin C and creatinine should be conducted, with special reference to diabetes status. Anyway, the aging effect may be important for the adverse health outcomes by decreased eGFR.

Second, the Chronic Kidney Disease Prognosis Consortium3 had reported about a meta-analysis that HRs of eGFR and urinary albumin–creatinine ratio (UACR) for all-cause mortality were higher in women than men. Losito et al.4 investigated the association of reduced kidney function, diabetes, and arterial hypertension with mortality in patients with cardiovascular disease. All-cause mortality was significantly associated with aging, male sex, and reduced eGFR only in patients with chronic ischemic heart disease, and diabetes or arterial hypertension did not contribute to the association. I recommend further studies to evaluate the mortality risk by reduced eGFR with special reference to sex difference because there are sex differences in the lifestyle factors, several clinical outcomes, and predictive equation of eGFR. Regarding the interaction of diabetes on the association, other comorbidities might also contribute to the association between reduced eGFR and subsequent all-cause mortality. Anyway, the magnitude of each comorbidity on the association should be examined.



中文翻译:

估计肾小球滤过率和全因死亡风险

刘等人。1进行了一项前瞻性研究,旨在检验几种估计肾小球滤过率 (eGFR) 与全因死亡率之间的关联,特别是糖尿病状况。受试者的平均年龄约为 60 岁,eGFR 测量结果分为三组:正常、适度下降和慢性肾脏病 (CKD)。在糖尿病患者中,由 eGFR 与胱抑素 C 以及胱抑素 C 和肌酐联合定义的 CKD 调整后风险比 (HR) 显着增加。相比之下,使用任何全因死亡率估计方程得出的 eGFR 和 CKD 适度下降的调整后 HR 显着增加。我对他们的学习有些担忧。

首先,侯赛因等人。2研究了 eGFR 与不良后果的年龄特异性关联。通过将特定年龄的 eGFR 参考设置为对照,18-39 岁、40 岁受试者的复合不良结局(全因死亡率、任何心血管事件和肾衰竭)的 eGFR 适度降低的调整后 HR (95% CI) –49 和 50-65 分别为 1.42 (1.35–1.49)、1.13 (1.10–1.16) 和 1.08 (1.07–1.09)。尽管eGFR轻度降低的受试者复合不良结局发生率的绝对风险随着年龄的增长而增加,但应特别关注年轻一代的复合不良结局。他们使用血清肌酐来估计 eGFR,我认为应该使用胱抑素 C 以及胱抑素 C 和肌酐的组合进行额外分析,特别是糖尿病状况。无论如何,衰老效应可能对 eGFR 降低带来的不良健康结果很重要。

其次,慢性肾脏病预后联盟3报告了一项荟萃分析,表明女性全因死亡率的 eGFR 和尿白蛋白肌酐比值 (UACR) 的 HR 高于男性。洛西托等人。4研究了肾功能下降、糖尿病和动脉高血压与心血管疾病患者死亡率的关系。仅在患有慢性缺血性心脏病的患者中,全因死亡率与衰老、男性和 eGFR 降低显着相关,而糖尿病或动脉高血压与这种关联无关。我建议进一步研究通过降低 eGFR 来评估死亡风险,特别是性别差异,因为生活方式因素、一些临床结果和 eGFR 的预测方程存在性别差异。关于糖尿病对这种关联的相互作用,其他合并症也可能导致 eGFR 降低和随后的全因死亡率之间的关联。无论如何,应该检查每种合并症的关联程度。

更新日期:2023-12-06
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