影響慢性腎病進展之相關因子探討

Factors affecting progression of chronic kidney disease

楊如燁(Ju-Yeh Yang)

指導教授 ： 陳秀熙

國立臺灣大學/公共衛生學院/流行病學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.03510

摘要

無資料

關鍵字

慢性腎病 ； 末期腎病變 ； 多項式邏吉司模型 ； 交互作用 ； 重複測量 ； 時間相依模式

並列摘要

Although there are numerous studies addressing the clinical parameters governing the evolution of chronic kidney disease (CKD) into end-stage renal disease (ESRD), the results are inconsistent. We examined the relationship between clinical characteristics and chronic kidney disease progression with different perspectives using a cohort in Taiwan.
We enrolled 801 patients with chronic kidney disease stage 3 to 5 in one single medical center. We examined the different characteristics between CKD stages with application of cumulative and multinomial logit models. For longitudinal followed data, generalized estimating equation and generalized linear mixed model were adopted. We investigated the associations between covariates and time to ESRD by Cox regression models and checked the interaction between these covariates and CKD stages. We also applied time dependent Cox regression model for longitudinal followed data.
We found changing relationships between certain covariates and CKD stages in different models. Most biomarkers showed consistently progressive nature with advance of CKD stages, while some differences exist only between certain stages. There was significantly higher hazard for ESRD among those patients with more advanced CKD stages. Plasma levels of albumin, calcium, phosphorous, hematocrit and amount of proteinuria are independent and consistent risk factors of ESRD in multivariate regression model. However, there were significant interactions between several factors and CKD stages. Most of the associations tend to be stronger in CKD 3-4 and weaker or even lack of significance in CKD stage 5. The estimates of hazard ratios for ESRD differed between time-independent and time-dependent models.
This study provides solid evidence from domestic data about clinically pertinent risk factors in progression of CKD and clinical significance concerning CKD staging. These may form a basis for early intervention of modifiable factors to delay the progression of CKD.

並列關鍵字

chronic kidney disease ； end-stage renal disease ； polynomial logit model ； interaction ； repeated measurement ； time-dependent model

參考文獻

1. Wen CP, Cheng TY, Tsai MK, et al. All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet 2008;371:2173-82.

2. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-47.

3. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1-266.

4. Jones CA, McQuillan GM, Kusek JW, et al. Plasma creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 1998;32:992-9.

6. Lee PH, Chang HY, Tung CW, et al. Hypertriglyceridemia: an independent risk factor of chronic kidney disease in Taiwanese adults. Am J Med Sci 2009;338:185-9.