不同方程计算的eGFR对老年高血压患者心血管事件的预测能力比较

Comparison of the predictive ability of cardiovascular events in elderly hypertensive patients by estimated glomerular filtration rate calculated from different equations

摘要:

目的比较5种不同方程计算的估算肾小球滤过率(estimated glomerular filtration rate, eGFR)对老年高血压患者心血管事件的预测能力。 方法本研究对前瞻性招募的1 714例居住在上海北部社区的老年高血压患者进行事后分析。eGFR通过以下方程计算: 肾脏疾病饮食调整方程(modification of diet in renal disease, MDRD)、中国改良的肾脏疾病饮食调整方程(Chinese-abbreviated MDRD, c-aMDRD)、慢性肾病流行病学合作组方程(chronic kidney disease epidemiology collaboration, CKD-EPI)、亚洲改良的慢性肾病流行病学合作组方程(Asian-modified CKD-EPI, aCKD-EPI)以及中国改良的慢性肾病流行病学合作组方程(Chinese-modified CKD-EPI, cCKD-EPI)。主要终点为主要不良心血管事件(major adverse cardiovascular events, MACE)，次要终点为心血管死亡及全因死亡。 结果在5种eGFR方程中，eGFR<60 mL/(min·1.73 m2)的患病率7.9%(c-aMDRD)~20.7%(cCKD-EPI)。eGFR<60 mL/(min·1.73 m2)的患者MACE发生率及风险显著升高(P<0.05)。CKD-EPI、aCKD-EPI和cCKD-EPI方程在预测MACE、心血管死亡及全因死亡方面的能力显著优于MDRD和c-aMDRD方程，差异有统计学意义(P<0.05)。其中，cCKD-EPI方程在预测MACE方面的能力显著优于其他4种方程，差异有统计学意义(P<0.05)。 结论在上海北部社区老年高血压患者中，cCKD-EPI方程在预测MACE方面优于CKD-EPI、aCKD-EPI、MDRD和c-aMDRD方程。建议中国老年高血压患者可考虑优先使用cCKD-EPI方程进行肾功能评估。

Abstract:

ObjectiveTo compare the predictive ability of estimated glomerular filtration rate(eGFR) calculated with five different equations on cardiovascular events in elderly hypertensive patients. MethodsThis study presents a post hoc analysis of 1 714 elderly hypertensive patients who were prospectively recruited from communities in the northern Shanghai. The eGFR was calculated with the Modification of Diet in Renal Disease(MDRD), Chinese-abbreviated MDRD(c-aMDRD), Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI), Asian-modified CKD-EPI(aCKD-EPI), and Chinese-modified CKD-EPI(cCKD-EPI) equations. The primary endpoint was major adverse cardiovascular events(MACE), and secondary endpoints included cardiovascular death and all-cause mortality. ResultsThe prevalence of eGFR<60 mL/(min·1.73 m2) ranged from 7.9%(c-aMDRD) to 20.7%(cCKD-EPI) across the five equations. Patients with eGFR<60 mL/(min·1.73 m2) had significantly higher incidence and risk of MACE(P<0.05). The CKD-EPI, aCKD-EPI, and cCKD-EPI equations demonstrated significantly better predictive ability for MACE, cardiovascular death, and all-cause mortality when compared to the MDRD and c-aMDRD equations(all P <0.05). Notably, the cCKD-EPI equation outperformed the other four equations in predicting MACE(P<0.05). ConclusionAmong elderly hypertensive patients residing in northern Shanghai communities, the cCKD-EPI equation has superior performance than the CKD-EPI, aCKD-EPI, MDRD, and c-aMDRD equations in predicting MACE. Based on these findings, it is recommended that elderly hypertensive patients in China prioritize the use of the cCKD-EPI equation for renal function assessment.