背景：在中东和北非地区慢性肾脏病负担增加的队列中，研究估计的肾小球滤过率（eGFR）变化与死亡风险之间的关系。
方法：我们从德黑兰脂质和葡萄糖研究的前瞻性队列中纳入了2210名年龄≥50岁的参与者。eGFR测量的间隔是在2002-2005年至2009-2011年的检查之间，参与者被跟踪到2018年3月。使用CKD-EPI肌酐方程从血清肌酐估算肾小球滤过率。我们评估了肾功能快速下降的相关性，（定义为每年eGFR下降≥3ml/min/1.73m2）;超过6年的eGFR下降≥30％;肾功能下降（eGFR下降≥25％加上eGFR类别下降）与死亡率结果。
结果：在招募后14.3年的中位随访中，记录了315例全因死亡和112例心血管疾病死亡。肾功能快速下降的全因死亡的多变量校正风险比（HR）和95％置信区间（CI），eGFR在6年内下降≥30%，肾功能下降为1.68（1.24-2.27），2.01(1.46-2.78),和1.49（1.11-1.98），分别。无慢性肾病患者的全因死亡和肾功能快速下降的HR分别为1.41（1.03-1.91）和3.38（1.69-6.76），分别。关于心血管疾病相关和非心血管疾病相关死亡率也观察到了类似的发现。
结论：估计的GFR下降与死亡风险增加有关，表明其在普通人群中提供传统风险预测因子之外的额外预后信息的能力。
To investigate the association between estimated glomerular filtration rate (eGFR) change and mortality risk in a cohort from the Middle East and North Africa region with increasing chronic kidney disease burden.
We included 2210 participants aged ≥ 50 years from the prospective cohort of the Tehran Lipid and Glucose
Study. The interval for eGFR measurement was between the examinations in 2002-2005 to 2009-2011, and participants were followed through March 2018. Glomerular filtration rate was estimated from serum creatinine using the CKD-EPI creatinine equation. We assessed the association of rapid kidney function decline, (defined as annual eGFR decline ≥ 3 ml/min/1.73 m2 per year); ≥ 30% eGFR decline over six years; and certain drop in kidney function (≥ 25% eGFR decline plus drop in eGFR category) with mortality outcomes.
During a median follow-up of 14.3 years after recruitment, 315 all-cause and 112 cardiovascular disease deaths were recorded. The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause death for rapid kidney function decline, ≥ 30% decline in eGFR over 6 years, and drop in kidney function were 1.68 (1.24-2.27), 2.01 (1.46-2.78), and 1.49 (1.11-1.98), respectively. The HRs of all-cause death and for rapid kidney function decline in those without and with chronic kidney disease were 1.41 (1.03-1.91) and 3.38 (1.69-6.76), respectively. Similar findings were observed regarding cardiovascular disease-related and non-cardiovascular disease-related mortality.
Estimated GFR decline is associated with an increased mortality risk, indicating its ability to provide additional prognostic information beyond traditional risk predictors in the general population.
