臨牀透析 Vol.28 No.10(2-3)


特集名 CKDキャンペーンの成果と今後のCKD・透析医療
題名 CKD疫学研究の進捗状況と成果 (3) CKDコホート研究CKD-JACの研究成果
発刊年月 2012年 09月
著者 今井 圓裕 名古屋大学大学院医学系研究科腎臓内科学
【 要旨 】 日本CKDコホート研究(Chronic Kidney Disease Japan Cohort;CKD-JAC)は,腎臓専門医が管理するGFR 10~60 mL/min/1.73 m2のCKD患者約3,000名の前向き観察研究であり,腎機能低下,心血管疾患発症,死亡をアウトカムとして4年間の追跡調査を行っている.プロトコル論文ならびに登録患者のベースラインに関する論文はすでに出版されている(Imai:Hypertens. Res. 2008, Imai:Clin. Exp. Nephrol 2010, Akizawa:Clin. Exp. Nephrol. 2011).原疾患は腎炎患者約1,000名,糖尿病患者約1,100名,非糸球体腎炎で糖尿病を合併しない患者約900名からなる.平均年齢60.8歳,平均eGFR 28.6 mL/min/1.73 m2で平均血圧は131/76 mmHgである.脈圧,脈波伝達速度は,CKDステージが進むほど悪化しており,CKDの進行とともに動脈硬化の合併が示唆される.腎性貧血もCKDの進行とともに悪化したが,十分な腎性貧血の治療が行われていないことも示された.
Theme Outcomes of CKD Campaign and Future Treatments Concerning CKD and Dialysis
Title CKD-Japan Cohort study
Author Enyu Imai Nagoya University Graduate School of Medicine
[ Summary ] The "Chronic Kidney Disease Japan Cohort" (CKD-JAC) study was a prospective obser vational study. 3,087 CKD patients were enrolled with GFR 10-60 mL/min/1.73 m2 from April 2007 to December 2008. The causes of CKD were glomerulonephritis (GN, n=948) and diabetes (n=1,120). Subjects were diagnosed with diabetic nephropathy (n=613), and non-diabetic, non-GN (n=909). The baseline mean eGFR (SD) was 28.6 (11.8) mL/min/1.73 m2 and the mean (SD) albuminuria rate was 976 (1,340) mg/gCr. More than 90 % of participants had hypertension but it was well controlled to 131/76 mmHg. Angiotensin receptor blockers were used for more than 70 % of the patients. Cardiovascular cormorbidity was attributed to ischemic heart disease (15 %), stroke (11.5 %), heart failure (3.9 %) and arteriosclerosis obliterans (3.6 %). The incidence of arteriosclerosis seems to be high in advanced CKD patients and diabetic patients because the pulse wave velocity (PWV) as well as pulse pressure is high. The mean Hb (SD) level was 12.06 (1.84) g/dL and the mean ferritin level was 137.5 (137.2) ng/dL. 946 out of 2,930 subjects were anemic, defined as having levels under 11 g/dL. ECGS and echocardiography were recorded and patients' 24 hour ASBPM levels were measured in approximately 1,000 CKD patients. Longitudinal analysis of cohort studies will provide important information concerning risk factors for ESRD and CVD.
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