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终末期肾病相关健康检查中估计肾小球滤过率的年变化

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2025-04-12 13:13

AbstractEstimated glomerular filtration rate (eGFR) variation is associated with end-stage kidney disease (ESKD) development in patients with chronic kidney disease; whether annual variations in eGFR at health check-ups is associated with ESKD risk in the general population is unclear. We conducted a retrospective cohort study using Japanese national medical insurance claims from 2013 to 2020.

摘要估计的肾小球滤过率（eGFR）变化与慢性肾病患者的终末期肾病（ESKD）发展有关；健康检查时eGFR的年度变化是否与普通人群的ESKD风险相关尚不清楚。我们使用2013年至2020年的日本国家医疗保险索赔进行了回顾性队列研究。

Individuals who had their eGFR levels measured three times in annual health check-ups were included (N = 115,191), and the coefficient of variation of eGFR (CVeGFR) was calculated from 3-point eGFR. The end-point was ESKD as reported in the claims data. We analyzed the association between CVeGFR and ESKD incidence after adjusting for conventional ESKD risk factors.

包括在年度健康检查中三次测量eGFR水平的个体（N=115191），eGFR变异系数（CVeGFR）由3点eGFR计算。索赔数据中报告的终点是ESKD。在调整常规ESKD危险因素后，我们分析了CVeGFR与ESKD发病率之间的关联。

The CVeGFR median distribution was 5.7% (interquartile range: 3.5–8.5%). During a median follow-up period of 3.74 years, 164 patients progressed to ESKD. ESKD incidence was significantly higher in the highest quartile group (CVeGFR ≥ 8.5%) than in the other groups (P < 0.0001). After adjusting for risk factors, individuals with CVeGFR ≥ 8.5% had a significantly high ESKD incidence (adjusted hazard ratio: 3.01; 95% CI 2.14–4.30).

CVeGFR的中位数分布为5.7%（四分位间距：3.5-8.5%）。在中位随访3.74年期间，164名患者进展为ESKD。最高四分位数组（CVeGFR≥8.5%）的ESKD发病率显着高于其他组（P<0.0001）。调整危险因素后，CVeGFR≥8.5%的个体ESKD发病率显着较高（校正风险比：3.01；95%CI 2.14-4.30）。

High CVeGFR in annual health check-ups was associated with high ESKD incidence, independent of its other conventional risk factors, in the general population..

年度健康检查中的高CVeGFR与普通人群中ESKD的高发病率相关，与其其他常规危险因素无关。。

IntroductionChronic kidney disease is a high-risk condition for end-stage kidney disease and cardiovascular disease1,2. Given the increasing prevalence of chronic kidney disease globally, preventing the onset/progression of chronic kidney disease is a social and economic issue because it affects an individual’s health and quality of life3.

引言慢性肾病是终末期肾病和心血管疾病的高危疾病1,2。鉴于全球慢性肾病的患病率不断上升，预防慢性肾病的发作/进展是一个社会和经济问题，因为它会影响个人的健康和生活质量3。

In Japan, approximately 13% of the adult population (13.3 million) is diagnosed with chronic kidney disease4, and estimated glomerular filtration rate (eGFR) is evaluated during annual health check-ups for adults aged ≥ 40 years to help prevent chronic kidney disease. However, effective methods for early identification of individuals with progressive chronic kidney disease who are at high risk for end-stage kidney disease have not been established.A decreased eGFR slope predicts end-stage kidney disease, cardiovascular events, and all-cause mortality5,6.

在日本，大约13%的成年人口（1330万）被诊断出患有慢性肾脏疾病4，并且在40岁以上的成年人的年度健康检查中评估了估计的肾小球滤过率（eGFR），以帮助预防慢性肾脏疾病。然而，尚未建立有效的方法来早期识别患有终末期肾病高风险的进行性慢性肾病患者。eGFR斜率降低可预测终末期肾病，心血管事件和全因死亡率5,6。

The 2012 Kidney Disease: Improving Global Outcomes guideline defines rapid eGFR decline as > 5 mL/min/1.73 m2/year7. Reduced eGFR slope is useful as a surrogate marker for end-stage kidney disease8,9,10; however, end-stage kidney disease events also occur in people with an increased eGFR slope, especially in short-term evaluation11,12,13.

2012年肾脏疾病：改善全球结果指南将eGFR快速下降定义为>5 mL/min/1.73 m2/年7。降低的eGFR斜率可用作终末期肾病的替代标志物8,9,10；然而，终末期肾病事件也发生在eGFR斜率增加的人群中，特别是在短期评估中11,12,13。

A meta-analysis has shown that an increased eGFR slope is associated with increased end-stage kidney disease, indicating a “U-shape” association between eGFR slope and the incidence of end-stage kidney disease13. This phenomenon implies that eGFR variability affects end-stage kidney disease development.Previous studies have shown that visit-to-visit variability of eGFR is associated with an increased incidence of end-stage kidney disease and all-cause death14,15.

荟萃分析显示，eGFR斜率增加与终末期肾病增加有关，表明eGFR斜率与终末期肾病发病率之间存在“U形”关联13。这种现象意味着eGFR变异性会影响终末期肾脏疾病的发展。先前的研究表明，eGFR的访视变异性与终末期肾病和全因死亡的发病率增加有关14,15。

A recent report has demonstrated that a 1-year coefficient of variation of eGFR (CVeGFR).

最近的一份报告表明，eGFR的1年变异系数（CVeGFR）。

The datasets generated and/or analyzed during the current study are not publicly available due to the Nara Kokuho Database regulation, but are available from the corresponding author on reasonable request.

由于Nara Kokuho数据库法规，当前研究期间生成和/或分析的数据集无法公开获得，但可根据合理要求从通讯作者处获得。

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Download referencesAcknowledgementsWe thank Editage (http://www.editage.com) for English language editing. This study was supported by the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (KAKENHI) (21K10451, 22H03355, 23H00507, and 21K10474) and by the Health Science and Labor Research Grants (21IA1006).Author informationAuthor notesThese authors contributed equally: Sadanori Okada and Yuichi Nishioka.Authors and AffiliationsDepartment of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, JapanSadanori Okada, Yuichi Nishioka, Miyuki Koizumi, Fumika Kamitani, Hiroki Nakajima, Yukako Kurematsu & Yutaka TakahashiDepartment of Public Health, Health Management, and Policy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, JapanYuichi Nishioka, Sinichiro Kubo, Tomoya Myojin, Tatsuya Noda & Tomoaki ImamuraDepartment of Medical and Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, JapanKoshiro KanaokaNara Prefecture Seiwa Medical Center, 1-14-16 Mimuro, Sango, Ikoma-gun, Nara, JapanYoshihiko SaitoAuthorsSadanori OkadaView author publicationsYou can also search for this author in.

下载参考文献致谢我们感谢编辑(http://www.editage.com)用于英语编辑。这项研究得到了日本科学研究促进会（KAKENHI）（21K10451、22H03355、23H00507和21K10474）和健康科学与劳动研究基金（21IA1006）的支持。作者信息作者注意到这些作者做出了同样的贡献：Sadanori Okada和Yuichi Nishioka。作者和所属机构奈良医科大学糖尿病与内分泌系，840 Shijo cho，Kashihara，奈良，634-8522，日本丹诺里冈田，Yuichi Nishioka，Miyuki Koizumi，Fumika Kamitani，Hiroki Nakajima，Kurematsu和Yutako TakahashiDepartment of Public Health，Health Management，and Policy，奈良医科大学，840 Shijo cho，Kashihara，奈良，634-8521，JapanYuichi Nishioka，Sinichiro Kubo，Tomoya Myojin，Tatsuya野田和今村友明国家大脑和心血管中心医学和信息管理系，日本大阪Suita Kishibe-Shimachi 6-1，日本大阪金冈原县Seiwa医学中心，日本奈良市三谷县Mimuro 1-14-16，Ikoma gun，Nara，JapanYoshihiko SaitoAuthorsSadanori OkadaView作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsSO designed the study, analyzed the data, and wrote and edited the manuscript. YN performed data curation, analyzed the data, and reviewed/edited the manuscript. KK contributed to data curation. MK, FK, HN, and YK contributed to discussion and reviewed the manuscript.

PubMed Google ScholarContributionsSO设计了这项研究，分析了数据，撰写并编辑了手稿。YN进行了数据整理，分析了数据，并审查/编辑了手稿。KK为数据管理做出了贡献。MK，FK，HN和YK参与了讨论并审阅了手稿。

SK, TM, and TN contributed to developing methodology. YS contributed to the discussion and reviewed the manuscript. TI contributed to developing the methodology and reviewed/edited the manuscript. YT contributed to the discussion and reviewed/edited the manuscript.Corresponding authorsCorrespondence to.

SK，TM和TN为开发方法做出了贡献。YS为讨论做出了贡献，并审阅了手稿。TI为开发方法做出了贡献，并审查/编辑了手稿。YT为讨论做出了贡献，并审查/编辑了手稿。通讯作者通讯。

Sadanori Okada or Yuichi Nishioka.Ethics declarations

冈田正男或西冈佑一。道德宣言

Competing interests

相互竞争的利益

SO has received research grants from Japanese Red Cross Society and speaker fees from Taisho, Mitsubishi Tanabe, Sumitomo, Eli Lilly, Boehringer Ingelheim, Daiichi Sankyo, Novartis, Novo Nordisk, Mochida, Kyowa Kirin, Terumo, and Ono. YN has received consultant fees from Novo Nordisk and speaker fees from Daiichi Sankyo and Sanofi.

SO获得了日本红十字会的研究资助，并获得了大正，三菱田边，住友，礼来，勃林格殷格翰，第一三共，诺华，诺和诺德，Mochida，Kyowa Kirin，Terumo和Ono的演讲费。YN收到了诺和诺德的顾问费和第一三共和赛诺菲的演讲费。

FK has received speaker fees from Sumitomo, Sanofi, and Kyowa Kirin. HN has received speaker fees from Sumitomo, Novo Nordisk, Kowa, and Sanofi. TM has received consultant fees from Health Insurance Claims Review & Reimbursement services. YS has received research grants from Otsuka, Boehringer Ingelheim, and Novartis and speakers’ bureau/honorarium from Otsuka, Boehringer Ingelheim, and Novartis.

FK收到了住友、赛诺菲和协和麒麟的演讲费。HN收到了住友、诺和诺德、科瓦和赛诺菲的演讲费。TM已收到健康保险索赔审查和报销服务的顾问费。YS获得了大冢、勃林格殷格翰和诺华的研究资助，以及大冢、勃林格殷格翰和诺华的演讲者局/酬金。

YT has received consultant fees from Novo Nordisk, Otsuka, and Recordati and speaker fees from Novo Nordisk, Sumitomo, Eli Lilly, Ono, Novartis, Boehringer Ingelheim, AstraZeneca, and Kyowa Kirin. The other authors declare no conflicts of interest..

YT收到了诺和诺德、大冢和Recordati的顾问费，以及诺和诺德、住友、礼来、小野、诺华、勃林格殷格翰、阿斯利康和麒麟的演讲者费。其他作者声明没有利益冲突。。

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Reprints and permissionsAbout this articleCite this articleOkada, S., Nishioka, Y., Kanaoka, K. et al. Annual variation of estimated glomerular filtration rate in health check-ups associated with end-stage kidney disease.

转载和许可本文引用本文Okada，S.，Nishioka，Y.，Kanaoka，K。等人。与终末期肾病相关的健康检查中估计肾小球滤过率的年度变化。

Sci Rep 14, 21065 (2024). https://doi.org/10.1038/s41598-024-72353-8Download citationReceived: 25 May 2024Accepted: 05 September 2024Published: 10 September 2024DOI: https://doi.org/10.1038/s41598-024-72353-8Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1421065（2024）。https://doi.org/10.1038/s41598-024-72353-8Download引文收到日期：2024年5月25日接受日期：2024年9月5日发布日期：2024年9月10日OI：https://doi.org/10.1038/s41598-024-72353-8Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsAnnual health check-upCoefficient of variation of estimated glomerular filtration rateEnd-stage kidney diseaseMedical insurance claims data

关键词年度健康检查估计肾小球滤过率变异系数终末期肾病医疗保险索赔数据

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