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Abstract：
Understanding the association between compliance to the Chronic Kidney Disease (CKD) guidelines in real-world clinical settings and renal outcomes remains a critical gap in knowledge. A comprehensive analysis was conducted using data from a national, multicenter CKD registry. This study included 4,455 patients with an estimated glomerular filtration rate (eGFR) measurement on the index date and eight additional metrics recorded within six months. These metrics comprised serum electrolyte levels, low-density lipoprotein cholesterol, hemoglobin, and the use of renin-angiotensin system inhibitors. The primary outcome was a composite of renal events, defined by a decline in eGFR to < 15 mL/min/1.73 m2 or a reduction of ≥ 30% in eGFR, confirmed by follow-up tests. Over a median follow-up of 513 days, 838 renal events were observed. High serum potassium levels (> 5.4 mmol/L) were associated with increased event rates compared to lower levels. Similarly, low serum sodium-chloride levels (< 33) correlated with higher event rates. Usage of renin-angiotensin system inhibitors, low serum calcium (< 8.4 mg/dL), and high uric acid levels (> 7.0 mg/dL) were also linked to increased events. Conversely, higher hemoglobin levels (≥ 13 g/dL) were associated with lower event rates. Compliance to guidelines, categorized into quartiles based on the number of met metrics, revealed a significantly reduced risk of events in the highest compliance group (meeting 8 metrics) compared to the lowest (0-5 metrics). Compliance to CKD guidelines in clinical practice is significantly associated with improved renal outcomes, emphasizing the need for guideline-concordant care in the management of CKD.
摘要：
了解在现实世界临床环境中对慢性肾脏病（CKD）指南的依从性与肾脏结局之间的关联仍然是知识上的关键差距。使用来自全国的数据进行了全面分析，多中心CKD注册表。这项研究包括4,455名患者，他们在索引日期进行了估计的肾小球滤过率（eGFR）测量，并在六个月内记录了八个其他指标。这些指标包括血清电解质水平，低密度脂蛋白胆固醇，血红蛋白,以及肾素-血管紧张素系统抑制剂的使用。主要结果是肾脏事件的复合，定义为eGFR下降至<15mL/min/1.73m2或eGFR下降≥30%，通过后续测试证实。中位随访513天，观察到838例肾脏事件。与较低水平相比，高血清钾水平（>5.4mmol/L）与事件发生率增加相关。同样，低血清氯化钠水平(<33)与较高的事件发生率相关.肾素-血管紧张素系统抑制剂的使用，低血清钙（<8.4mg/dL），高尿酸水平(>7.0mg/dL)也与事件增加有关.相反，较高的血红蛋白水平(≥13g/dL)与较低的事件发生率相关.遵守准则，根据满足的指标数量分为四分位数，与最低组(0-5个指标)相比,最高组(符合8个指标)的事件风险显著降低.在临床实践中符合CKD指南与改善肾脏结局显着相关，强调CKD管理中指南一致护理的必要性。
