AbstractEstimated glomerular filtration rate (eGFR) variation is associated with end-stage kidney disease (ESKD) development in patients with chronic kidney disease; whether annual variations in eGFR at health check-ups is associated with ESKD risk in the general population is unclear. We conducted a retrospective cohort study using Japanese national medical insurance claims from 2013 to 2020.

摘要估計(jì)的腎小球?yàn)V過率（eGFR）變化與慢性腎病患者的終末期腎?。‥SKD）發(fā)展有關(guān)；健康檢查時eGFR的年度變化是否與普通人群的ESKD風(fēng)險(xiǎn)相關(guān)尚不清楚。我們使用2013年至2020年的日本國家醫(yī)療保險(xiǎn)索賠進(jìn)行了回顧性隊(duì)列研究。

Individuals who had their eGFR levels measured three times in annual health check-ups were included (N?=?115,191), and the coefficient of variation of eGFR (CVeGFR) was calculated from 3-point eGFR. The end-point was ESKD as reported in the claims data. We analyzed the association between CVeGFR and ESKD incidence after adjusting for conventional ESKD risk factors.

包括在年度健康檢查中三次測量eGFR水平的個體（N=115191），eGFR變異系數(shù)（CVeGFR）由3點(diǎn)eGFR計(jì)算。索賠數(shù)據(jù)中報(bào)告的終點(diǎn)是ESKD。在調(diào)整常規(guī)ESKD危險(xiǎn)因素后，我們分析了CVeGFR與ESKD發(fā)病率之間的關(guān)聯(lián)。

The CVeGFR median distribution was 5.7% (interquartile range: 3.5–8.5%). During a median follow-up period of 3.74 years, 164 patients progressed to ESKD. ESKD incidence was significantly higher in the highest quartile group (CVeGFR?≥?8.5%) than in the other groups (P?<?0.0001). After adjusting for risk factors, individuals with CVeGFR?≥?8.5% had a significantly high ESKD incidence (adjusted hazard ratio: 3.01; 95% CI 2.14–4.30).

CVeGFR的中位數(shù)分布為5.7%（四分位間距：3.5-8.5%）。在中位隨訪3.74年期間，164名患者進(jìn)展為ESKD。最高四分位數(shù)組（CVeGFR≥8.5%）的ESKD發(fā)病率顯著高于其他組（P<0.0001）。調(diào)整危險(xiǎn)因素后，CVeGFR≥8.5%的個體ESKD發(fā)病率顯著較高（校正風(fēng)險(xiǎn)比：3.01；95%CI 2.14-4.30）。

High CVeGFR in annual health check-ups was associated with high ESKD incidence, independent of its other conventional risk factors, in the general population..

年度健康檢查中的高CVeGFR與普通人群中ESKD的高發(fā)病率相關(guān)，與其其他常規(guī)危險(xiǎn)因素?zé)o關(guān)。。

IntroductionChronic kidney disease is a high-risk condition for end-stage kidney disease and cardiovascular disease1,2. Given the increasing prevalence of chronic kidney disease globally, preventing the onset/progression of chronic kidney disease is a social and economic issue because it affects an individual’s health and quality of life3.

引言慢性腎病是終末期腎病和心血管疾病的高危疾病1,2。鑒于全球慢性腎病的患病率不斷上升，預(yù)防慢性腎病的發(fā)作/進(jìn)展是一個社會和經(jīng)濟(jì)問題，因?yàn)樗鼤绊憘€人的健康和生活質(zhì)量3。

In Japan, approximately 13% of the adult population (13.3 million) is diagnosed with chronic kidney disease4, and estimated glomerular filtration rate (eGFR) is evaluated during annual health check-ups for adults aged?≥?40 years to help prevent chronic kidney disease. However, effective methods for early identification of individuals with progressive chronic kidney disease who are at high risk for end-stage kidney disease have not been established.A decreased eGFR slope predicts end-stage kidney disease, cardiovascular events, and all-cause mortality5,6.

在日本，大約13%的成年人口（1330萬）被診斷出患有慢性腎臟疾病4，并且在40歲以上的成年人的年度健康檢查中評估了估計(jì)的腎小球?yàn)V過率（eGFR），以幫助預(yù)防慢性腎臟疾病。然而，尚未建立有效的方法來早期識別患有終末期腎病高風(fēng)險(xiǎn)的進(jìn)行性慢性腎病患者。eGFR斜率降低可預(yù)測終末期腎病，心血管事件和全因死亡率5,6。

The 2012 Kidney Disease: Improving Global Outcomes guideline defines rapid eGFR decline as?>?5 mL/min/1.73 m2/year7. Reduced eGFR slope is useful as a surrogate marker for end-stage kidney disease8,9,10; however, end-stage kidney disease events also occur in people with an increased eGFR slope, especially in short-term evaluation11,12,13.

2012年腎臟疾?。焊纳迫蚪Y(jié)果指南將eGFR快速下降定義為>5 mL/min/1.73 m2/年7。降低的eGFR斜率可用作終末期腎病的替代標(biāo)志物8,9,10；然而，終末期腎病事件也發(fā)生在eGFR斜率增加的人群中，特別是在短期評估中11,12,13。

A meta-analysis has shown that an increased eGFR slope is associated with increased end-stage kidney disease, indicating a “U-shape” association between eGFR slope and the incidence of end-stage kidney disease13. This phenomenon implies that eGFR variability affects end-stage kidney disease development.Previous studies have shown that visit-to-visit variability of eGFR is associated with an increased incidence of end-stage kidney disease and all-cause death14,15.

薈萃分析顯示，eGFR斜率增加與終末期腎病增加有關(guān)，表明eGFR斜率與終末期腎病發(fā)病率之間存在“U形”關(guān)聯(lián)13。這種現(xiàn)象意味著eGFR變異性會影響終末期腎臟疾病的發(fā)展。先前的研究表明，eGFR的訪視變異性與終末期腎病和全因死亡的發(fā)病率增加有關(guān)14,15。

A recent report has demonstrated that a 1-year coefficient of variation of eGFR (CVeGFR).

最近的一份報(bào)告表明，eGFR的1年變異系數(shù)（CVeGFR）。

The datasets generated and/or analyzed during the current study are not publicly available due to the Nara Kokuho Database regulation, but are available from the corresponding author on reasonable request.

由于Nara Kokuho數(shù)據(jù)庫法規(guī)，當(dāng)前研究期間生成和/或分析的數(shù)據(jù)集無法公開獲得，但可根據(jù)合理要求從通訊作者處獲得。

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Download referencesAcknowledgementsWe thank Editage (http://www.editage.com) for English language editing. This study was supported by the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (KAKENHI) (21K10451, 22H03355, 23H00507, and 21K10474) and by the Health Science and Labor Research Grants (21IA1006).Author informationAuthor notesThese authors contributed equally: Sadanori Okada and Yuichi Nishioka.Authors and AffiliationsDepartment of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, JapanSadanori Okada, Yuichi Nishioka, Miyuki Koizumi, Fumika Kamitani, Hiroki Nakajima, Yukako Kurematsu & Yutaka TakahashiDepartment of Public Health, Health Management, and Policy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, JapanYuichi Nishioka, Sinichiro Kubo, Tomoya Myojin, Tatsuya Noda & Tomoaki ImamuraDepartment of Medical and Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, JapanKoshiro KanaokaNara Prefecture Seiwa Medical Center, 1-14-16 Mimuro, Sango, Ikoma-gun, Nara, JapanYoshihiko SaitoAuthorsSadanori OkadaView author publicationsYou can also search for this author in.

下載參考文獻(xiàn)致謝我們感謝編輯(http://www.editage.com)用于英語編輯。這項(xiàng)研究得到了日本科學(xué)研究促進(jìn)會（KAKENHI）（21K10451、22H03355、23H00507和21K10474）和健康科學(xué)與勞動研究基金（21IA1006）的支持。作者信息作者注意到這些作者做出了同樣的貢獻(xiàn)：Sadanori Okada和Yuichi Nishioka。作者和所屬機(jī)構(gòu)奈良醫(yī)科大學(xué)糖尿病與內(nèi)分泌系，840 Shijo cho，Kashihara，奈良，634-8522，日本丹諾里岡田，Yuichi Nishioka，Miyuki Koizumi，F(xiàn)umika Kamitani，Hiroki Nakajima，Kurematsu和Yutako TakahashiDepartment of Public Health，Health Management，and Policy，奈良醫(yī)科大學(xué)，840 Shijo cho，Kashihara，奈良，634-8521，JapanYuichi Nishioka，Sinichiro Kubo，Tomoya Myojin，Tatsuya野田和今村友明國家大腦和心血管中心醫(yī)學(xué)和信息管理系，日本大阪Suita Kishibe-Shimachi 6-1，日本大阪金岡原縣Seiwa醫(yī)學(xué)中心，日本奈良市三谷縣Mimuro 1-14-16，Ikoma gun，Nara，JapanYoshihiko SaitoAuthorsSadanori OkadaView作者出版物您也可以在中搜索這位作者。

PubMed Google ScholarYuichi NishiokaView author publicationsYou can also search for this author in

PubMed Google ScholarYuichi NishiokaView作者出版物您也可以在

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PubMed Google ScholarContributionsSO designed the study, analyzed the data, and wrote and edited the manuscript. YN performed data curation, analyzed the data, and reviewed/edited the manuscript. KK contributed to data curation. MK, FK, HN, and YK contributed to discussion and reviewed the manuscript.

PubMed Google ScholarContributionsSO設(shè)計(jì)了這項(xiàng)研究，分析了數(shù)據(jù)，撰寫并編輯了手稿。YN進(jìn)行了數(shù)據(jù)整理，分析了數(shù)據(jù)，并審查/編輯了手稿。KK為數(shù)據(jù)管理做出了貢獻(xiàn)。MK，F(xiàn)K，HN和YK參與了討論并審閱了手稿。

SK, TM, and TN contributed to developing methodology. YS contributed to the discussion and reviewed the manuscript. TI contributed to developing the methodology and reviewed/edited the manuscript. YT contributed to the discussion and reviewed/edited the manuscript.Corresponding authorsCorrespondence to.

SK，TM和TN為開發(fā)方法做出了貢獻(xiàn)。YS為討論做出了貢獻(xiàn)，并審閱了手稿。TI為開發(fā)方法做出了貢獻(xiàn)，并審查/編輯了手稿。YT為討論做出了貢獻(xiàn)，并審查/編輯了手稿。通訊作者通訊。

Sadanori Okada or Yuichi Nishioka.Ethics declarations

岡田正男或西岡佑一。道德宣言

Competing interests

相互競爭的利益

SO has received research grants from Japanese Red Cross Society and speaker fees from Taisho, Mitsubishi Tanabe, Sumitomo, Eli Lilly, Boehringer Ingelheim, Daiichi Sankyo, Novartis, Novo Nordisk, Mochida, Kyowa Kirin, Terumo, and Ono. YN has received consultant fees from Novo Nordisk and speaker fees from Daiichi Sankyo and Sanofi.

SO獲得了日本紅十字會的研究資助，并獲得了大正，三菱田邊，住友，禮來，勃林格殷格翰，第一三共，諾華，諾和諾德，Mochida，Kyowa Kirin，Terumo和Ono的演講費(fèi)。YN收到了諾和諾德的顧問費(fèi)和第一三共和賽諾菲的演講費(fèi)。

FK has received speaker fees from Sumitomo, Sanofi, and Kyowa Kirin. HN has received speaker fees from Sumitomo, Novo Nordisk, Kowa, and Sanofi. TM has received consultant fees from Health Insurance Claims Review & Reimbursement services. YS has received research grants from Otsuka, Boehringer Ingelheim, and Novartis and speakers’ bureau/honorarium from Otsuka, Boehringer Ingelheim, and Novartis.

FK收到了住友、賽諾菲和協(xié)和麒麟的演講費(fèi)。HN收到了住友、諾和諾德、科瓦和賽諾菲的演講費(fèi)。TM已收到健康保險(xiǎn)索賠審查和報(bào)銷服務(wù)的顧問費(fèi)。YS獲得了大冢、勃林格殷格翰和諾華的研究資助，以及大冢、勃林格殷格翰和諾華的演講者局/酬金。

YT has received consultant fees from Novo Nordisk, Otsuka, and Recordati and speaker fees from Novo Nordisk, Sumitomo, Eli Lilly, Ono, Novartis, Boehringer Ingelheim, AstraZeneca, and Kyowa Kirin. The other authors declare no conflicts of interest..

YT收到了諾和諾德、大冢和Recordati的顧問費(fèi)，以及諾和諾德、住友、禮來、小野、諾華、勃林格殷格翰、阿斯利康和麒麟的演講者費(fèi)。其他作者聲明沒有利益沖突。。

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You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

根據(jù)本許可證，您無權(quán)共享源自本文或其部分的改編材料。本文中的圖像或其他第三方材料包含在文章的知識共享許可證中，除非該材料的信用額度中另有說明。如果材料未包含在文章的知識共享許可中，并且您的預(yù)期用途不受法律法規(guī)的許可或超出許可用途，則您需要直接獲得版權(quán)所有者的許可。

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要查看此許可證的副本，請?jiān)L問http://creativecommons.org/licenses/by-nc-nd/4.0/..

Reprints and permissionsAbout this articleCite this articleOkada, S., Nishioka, Y., Kanaoka, K. et al. Annual variation of estimated glomerular filtration rate in health check-ups associated with end-stage kidney disease.

轉(zhuǎn)載和許可本文引用本文Okada，S.，Nishioka，Y.，Kanaoka，K。等人。與終末期腎病相關(guān)的健康檢查中估計(jì)腎小球?yàn)V過率的年度變化。

Sci Rep 14, 21065 (2024). https://doi.org/10.1038/s41598-024-72353-8Download citationReceived: 25 May 2024Accepted: 05 September 2024Published: 10 September 2024DOI: https://doi.org/10.1038/s41598-024-72353-8Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1421065（2024）。https://doi.org/10.1038/s41598-024-72353-8Download引文收到日期：2024年5月25日接受日期：2024年9月5日發(fā)布日期：2024年9月10日OI：https://doi.org/10.1038/s41598-024-72353-8Share本文與您共享以下鏈接的任何人都可以閱讀此內(nèi)容：獲取可共享鏈接對不起，本文目前沒有可共享的鏈接。復(fù)制到剪貼板。

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KeywordsAnnual health check-upCoefficient of variation of estimated glomerular filtration rateEnd-stage kidney diseaseMedical insurance claims data

關(guān)鍵詞年度健康檢查估計(jì)腎小球?yàn)V過率變異系數(shù)終末期腎病醫(yī)療保險(xiǎn)索賠數(shù)據(jù)

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