关键词: 慢性肾脏病, 糖尿病肾病, 估算的肾小球滤过率, 危险因素

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To determine the relationship between the shortterm decline of eGFR and the progression of chronic kidney disease (CKD).
Ｍｅｔｈｏｄｏｌｏｇｙ：The changes of eGFR within the first two years of initial referral of all CKD patients followed for more than 2 years in our department were retrospectively investigated. KaplanMeier method was used to compare the duration from first visit to stage 5 CKD of different diseases and the impact of various factors on disease progression was evaluate by Cox regression analysis.
Ｒｅｓｕｌｔｓ：The median period from first visit to stage 5 CKD was 58 years of the whole group, in which patients with diabetic nephropathy had significantly shorter period of 4 years. The average annual and twoyear rates of decline in eGFR were 98% and 216% in the whole group, while diabetic nephropathy showed remarkably higher rates of 227% and 410%. The median period from first visit to stage 5 CKD was 33 years in patients with more than 40% dicrease in eGFR within two years, which was notably shorter than those with slower decline of eGFR. Multivariate cox regression analysis indicated that male, diabetes, lower eGFR at first visit and rapid decline of eGFR within 2 years were risk factors for the progression of CKD, the use of ACEI/ARB therapy could slow the progression of kidney disease.
Ｃｏｎｃｌｕｓｉｏｎ：The decline of eGFR varies in different diseases, among which diabetic nephropathy has relatively faster rate of progression. The rapid decline of eGFR within 2 years is an independent risk factor for progression of CKD. Factors such as etiology, baseline eGFR and medications should be considered in clinical trials using lesser eGFR declines as a surrogate end point for progression of CKD.