两种方法估算蛋白质摄入量对慢性肾脏病预后评估价值比较研究OA

Objective To compare the value of dietary protein intake(DPI)estimated based on the serum urea nitrogen/creatinine ratio(sUCR)formula(DPIsUCR)with that of DPI estimated based on the Maroni formula(DPIMaroni)in assessing the prognosis of patients with chronic kidney disease(CKD).Methods Clinical data of CKD patients diagnosed and receiving limited protein diet education at Guangdong Provincial People's Hospital from January 2015 to September 2022 were analyzed retrospectively.The composite endpoint was defined as ≥50％reduction in estimated glomerular filtration rate(eGFR),or progression to end stage renal disease(ESRD),or occurrence of major adverse cardiovascular and cerebrovascular events(MACCE).DPIsUCR and DPIMaroni were calculated according to the formula specified in the literature respectively.Results A total of 1 033 patients were enrolled in the final analysis,with a median follow-up period of 18.73(8.47,32.88)months.Favorable consistency and stability of DPIsUCR and DPIMaroni was confirmed by Bland-Altman and differential analysis in CKD stage 1 to CKD stage 4 patients.Survival analysis indicated that the risk of composite endpoint events was significantly reduced in patients with DPIsUCR and DPIMaroni＜0.8 g/(kg·d)than in those with＞1.0 g/(kg·d)in CKD stage 4 patients.In addition,patients with low DPIsUCR[＜0.8 g/(kg·d)or 0.8-1.0 g/(kg·d)]had significantly lower risk of composite endpoint events compared to those with high DPIsUCR[＞1.0 g/(kg·d)]in patients with CKD stage 1 to stage 3,while DPIMnroni did not predict a significant reduction in the risk of composite endpoint events in the same population.Conclusion DPIsUCR has good consistency with DPIMaroni.In CKD stage 1 to stage 3,DPIsUCR is more sensitive than DPIMaroni in identifying patients at high risk of composite endpoint events.