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Abstract：
BACKGROUND: Patients with IgA nephropathy (IgAN), a chronic kidney disease (CKD), are significantly more likely to have cardiovascular (CV) mortality and morbidity than the general population. The occurrence of metabolic syndrome (MetS) and metabolic risk factors are independent risk factors for CV disease and renal progression. The purpose of this study was to determine how metabolic characteristics in a homogeneous population of CKD patients relate to prognosis.
METHODS: A total of 145 patients with CKD stages 1-4 diagnosed with IgA nephropathy (92 men and 53 women, aged 54.7 ± 13 years) were examined and monitored for a median of 190 months. All-cause mortality and any CV event, such as stroke, myocardial infarction, revascularization (CV), end-stage renal disease, and renal replacement therapy (renal), have been included in the composite endpoints (CV and renal).
RESULTS: Patients with MetS had significantly more primary endpoint events (23/65 patients vs. 15/60 patients, p < 0.001) compared to the non-MetS group. The MetS group had a statistically significant increase in both primary renal and CV endpoints (18/65 vs. 10/60, p = 0.001), and in CV endpoint events (7/65 vs. 6/60, p = 0.029) among the secondary endpoints (CV and renal separately). Based on Cox regression analysis, the main endpoint independent predictors of survival were dyslipidemia, eGFR, hemoglobin, urine albuminuria, and diabetes mellitus. Independent predictors of secondary renal endpoints were dyslipidemia, hemoglobin, urine albumin, and eGFR. Predictors of secondary cardiovascular endpoints were gender, BMI, and diabetes. When Kaplan-Meier curves were analyzed at the combined endpoints (CV and renal) or each endpoint independently, significant differences were seen between MetS and non-MetS. With more MetS components, the primary endpoint rate increased significantly (MetS comp. 0 vs. MetS comp. 2+, primary endpoints, p = 0.012).
CONCLUSIONS: Our results show that the metabolic profile has a prognostic role not only for renal endpoints but also for CV endpoints in IgAN. BMI, hyperuricemia, hypertension, and diabetes have a predictive value for the prognosis of IgA nephropathy.
METHODS: A total of 145 patients with CKD stages 1-4 diagnosed with IgA nephropathy (92 men and 53 women, aged 54.7 ± 13 years) were examined and monitored for a median of 190 months. All-cause mortality and any CV event, such as stroke, myocardial infarction, revascularization (CV), end-stage renal disease, and renal replacement therapy (renal), have been included in the composite endpoints (CV and renal).
RESULTS: Patients with MetS had significantly more primary endpoint events (23/65 patients vs. 15/60 patients, p < 0.001) compared to the non-MetS group. The MetS group had a statistically significant increase in both primary renal and CV endpoints (18/65 vs. 10/60, p = 0.001), and in CV endpoint events (7/65 vs. 6/60, p = 0.029) among the secondary endpoints (CV and renal separately). Based on Cox regression analysis, the main endpoint independent predictors of survival were dyslipidemia, eGFR, hemoglobin, urine albuminuria, and diabetes mellitus. Independent predictors of secondary renal endpoints were dyslipidemia, hemoglobin, urine albumin, and eGFR. Predictors of secondary cardiovascular endpoints were gender, BMI, and diabetes. When Kaplan-Meier curves were analyzed at the combined endpoints (CV and renal) or each endpoint independently, significant differences were seen between MetS and non-MetS. With more MetS components, the primary endpoint rate increased significantly (MetS comp. 0 vs. MetS comp. 2+, primary endpoints, p = 0.012).
CONCLUSIONS: Our results show that the metabolic profile has a prognostic role not only for renal endpoints but also for CV endpoints in IgAN. BMI, hyperuricemia, hypertension, and diabetes have a predictive value for the prognosis of IgA nephropathy.
摘要：
背景：IgA肾病（IgAN）患者，慢性肾病（CKD），与普通人群相比，心血管疾病（CV）死亡率和发病率明显更高。代谢综合征（MetS）的发生和代谢危险因素是CV疾病和肾脏进展的独立危险因素。这项研究的目的是确定CKD患者同质人群的代谢特征与预后的关系。
方法：共有145例CKD1-4期患者被诊断为IgA肾病（男性92例，女性53例，54.7±13岁）进行检查和监测，中位时间为190个月。全因死亡率和任何CV事件，如中风，心肌梗塞,血运重建（CV），终末期肾病,和肾脏替代疗法（肾脏），已包括在复合终点(CV和肾脏)中。
结果：MetS患者的主要终点事件明显增多（23/65例患者与15/60患者，p<0.001）与非MetS组相比。MetS组的原发性肾脏和CV终点均有统计学上的显着增加（18/65vs.10/60，p=0.001），和CV终点事件(7/65vs.6/60，p=0.029）在次要终点（CV和肾脏分开）中。基于Cox回归分析，生存的主要终点独立预测因子是血脂异常，eGFR,血红蛋白,尿白蛋白,和糖尿病。次要肾脏终点的独立预测因素是血脂异常，血红蛋白,尿白蛋白,和eGFR。次要心血管终点的预测因素是性别，BMI,和糖尿病。当Kaplan-Meier曲线在联合终点（CV和肾脏）或每个终点独立分析时，MetS和非MetS之间存在显著差异。有了更多的MetS组件，主要终点比率显著增加(MetScomp.0vs.大都会公司。2+,主要终点,p=0.012)。
结论：我们的结果表明，在IgAN中，代谢谱不仅对肾脏终点而且对CV终点具有预后作用。BMI,高尿酸血症,高血压,糖尿病对IgA肾病的预后有预测价值。
方法：共有145例CKD1-4期患者被诊断为IgA肾病（男性92例，女性53例，54.7±13岁）进行检查和监测，中位时间为190个月。全因死亡率和任何CV事件，如中风，心肌梗塞,血运重建（CV），终末期肾病,和肾脏替代疗法（肾脏），已包括在复合终点(CV和肾脏)中。
结果：MetS患者的主要终点事件明显增多（23/65例患者与15/60患者，p<0.001）与非MetS组相比。MetS组的原发性肾脏和CV终点均有统计学上的显着增加（18/65vs.10/60，p=0.001），和CV终点事件(7/65vs.6/60，p=0.029）在次要终点（CV和肾脏分开）中。基于Cox回归分析，生存的主要终点独立预测因子是血脂异常，eGFR,血红蛋白,尿白蛋白,和糖尿病。次要肾脏终点的独立预测因素是血脂异常，血红蛋白,尿白蛋白,和eGFR。次要心血管终点的预测因素是性别，BMI,和糖尿病。当Kaplan-Meier曲线在联合终点（CV和肾脏）或每个终点独立分析时，MetS和非MetS之间存在显著差异。有了更多的MetS组件，主要终点比率显著增加(MetScomp.0vs.大都会公司。2+,主要终点,p=0.012)。
结论：我们的结果表明，在IgAN中，代谢谱不仅对肾脏终点而且对CV终点具有预后作用。BMI,高尿酸血症,高血压,糖尿病对IgA肾病的预后有预测价值。
