目的:慢性肾脏病(CKD)患者发生不良事件的风险增加,早期死亡,和多重性。缺乏常规肾脏护理下的大型CKD队列中不良事件类型和发生率的详细概述。我们生成了一个交互式工具,以便在前瞻性中探索不良事件及其组合,观察性德国CKD(GCKD)研究。
方法:GCKD研究纳入了5217名接受常规肾脏护理的参与者,估计肾小球滤过率为30-60或>60mL/min/1.73m2,并且有明显的蛋白尿。心脏-,脑血管和外周血管,肾,感染,和癌症事件,以及死亡是按照标准操作程序裁定的。我们总结了这些时间到事件的数据点,以便在Rshiny应用程序中的交互式图形中进行探索。拟合到第一事件时间的多变量调整Cox模型。累积发生率函数,使用Kaplan-Meier曲线和相交图显示主要不良事件及其按性别和CKD病因的组合。
结果:中位数为6.5年,总共发生了10.271起事件,680名参与者(13.0%)死亡,2947名参与者(56.5%)经历了任何事件。新的公开互动平台使读者能够仔细检查不良事件及其组合以及死亡率趋势,作为更好地了解CKD多发病率的门户:每1000患者年的事件发生率因事件类型而异。CKD病因,和基线特征。最常见事件及其复发的发生率为113.6(心血管),75.0(肾),66.0(感染)。糖尿病肾病患者和男性患者更容易发生事件。
结论:这个全面的探索性工具可以可视化不良事件(https://gckd.迪兹.英国-埃尔兰根.de/),他们的组合,死亡率,CKD患者的多发病率可能是患者护理的宝贵资源,确定高危人群,卫生服务,和公共卫生政策规划。
OBJECTIVE: Persons with chronic kidney disease (CKD) are at increased risk of adverse events, early mortality, and multimorbidity. A detailed overview of adverse event types and rates from a large CKD cohort under regular nephrological care is missing. We generated an interactive tool to enable exploration of adverse events and their combinations in the prospective, observational German CKD (GCKD) study.
METHODS: The GCKD study enrolled 5217 participants under regular nephrological care with an estimated glomerular filtration rate of 30-60 or >60 mL/min/1.73m2 and an overt proteinuria. Cardio-, cerebro- and peripheral vascular, kidney, infection, and cancer events, as well as deaths were adjudicated following a standard operation procedure. We summarized these time-to-event data points for exploration in interactive graphs within an R shiny app. Multivariable adjusted Cox models for time to first event were fitted. Cumulative incidence functions, Kaplan-Meier curves and intersection plots were used to display main adverse events and their combinations by sex and CKD etiology.
RESULTS: Over a median of 6.5 years, 10 271 events occurred in total and 680 participants (13.0%) died while 2947 participants (56.5%) experienced any event. The new publicly available interactive platform enables readers to scrutinize adverse events and their combinations as well as mortality trends as a gateway to better understand multimorbidity in CKD: incident rates per 1000 patient-years varied by event type, CKD etiology, and baseline characteristics. Incidence rates for the most frequent events and their recurrence were 113.6 (cardiovascular), 75.0 (kidney), and 66.0 (infection). Participants with diabetic kidney disease and men were more prone to experiencing events.
CONCLUSIONS: This comprehensive explorative tool to visualize adverse events (https://gckd.diz.uk-erlangen.de/), their combination, mortality, and multimorbidity among persons with CKD may manifest as a valuable resource for patient care, identification of high-risk groups, health services, and public health policy planning.