Journal Information
Vol. 33. Issue. 2.March 2013
Pages 0-288
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Estrategia para estimar la progresión del riesgo de la enfermedad renal crónica, del riesgo cardiovascular y la remisión a nefrología: el estudio EPIRCE
Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study
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Pilar Gayoso-Diza, Alfonso Otero-Gonzálezb, Alfonso Otero-Gonzalezc, M. Xosé Rodríguez-Álvarezd, Maria Xose Rodriguez-Alvareze, Fernando Garcíaf, Fernando Garciag, Arturo González-Quintelah, Arturo Gonzalez-Quintelai, Ángel M. de Franciscoj, Angel M De Franciscok
a Unidad de Epidemiología Clínica, CHU de Santiago, Santiago de Compostela, A Coruña, España,
b Servicio de Nefrología, Complexo Hospitalario Universitario de Ourense, Ourense, Spain,
c NEFROLOGÍA, CHU de Ourense, Ourense, Ourense, España,
d Unidad de Epidemiología Clínica, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain,
e Unidad Epidemiologia Clinica, CHU de Santiago, Santiago de Compostela, A Coruña, España,
f Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Madrid, Spain,
g NEFROLOGIA, H. U. Puerta de Hierro, Madrid, Madrid, España,
h Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain,
i Medicina Interna, CHU de Santiago, Santiago de Compostela, A Coruña, España,
j Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Spain,
k NEFROLOGÍA, HU Valdecilla., Santander, Santander, España,
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Antecedentes: Si bien la prevalencia de la enfermedad renal crónica (ERC) es del 10-14 %, diversos estudios prospectivos indican que en las fases 3 y 4 existe una tasa baja de progresión hacia enfermedad renal terminal (ERT). Una clasificación correcta del riesgo de progresión basada en factores predictivos demostrados permitiría un mejor manejo de la ERC. Estudios recientes han demostrado el elevado valor predictivo de la clasificación que combina el valor estimado (e) de la tasa de filtrado glomerular (FG) con la ratio albúmina-creatinina (RAC) en orina. Realizamos una estimación del riesgo clínico de una progresión hacia una ERT y de mortalidad cardiovascular existente en la población general española basando la predicción en el uso combinado de las variables tasa (e) de FG y RAC. Materiales y métodos: Evaluación cruzada en la muestra Epirce, que era representativa de la población española mayor de 20 años. Para la estimación del FG se emplearon las fórmulas MDRD y CKD-EPI; se consideraba la existencia de microalbuminuria cuando los valores de RAC oscilaban entre 20-200 mg/g (hombres) o entre 30-300 mg/g (mujeres) y de macroalbuminuria cuando los valores superaban dichos límites. Se realizó una estimación de la prevalencia ponderada poblacionalmente del riesgo de progresión de ERC hacia ERT. Resultados: Con MDRD, el 1,4 % de la población adulta española presentaba un riesgo moderado de evolución hacia ERT; el 0,1 % un riesgo elevado y el 12,3 % un riesgo bajo. Con CKD-EPI, la tasa de riesgo moderado se elevaba hasta 1,7 % y la de riesgo bajo hasta 12,6 %; sin embargo, la tasa de riesgo elevado se mantenía estable. Conclusiones: La adición de la RAC a la tasa (e) de FG permite una mejor clasificación de la población en riesgo de deterioro renal relacionado con el Kidney/Disease Outcomes Quality Initiative, grados 3 y 4. La estimación de la tasa de FG mediante CKD-EPI modifica la distribución existente para el riesgo bajo y moderado.

Palabras clave:
Albuminuria
Palabras clave:
Pronóstico
Palabras clave:
Epidemiología
Palabras clave:
Enfermedad renal crónica
Palabras clave:
Clasificación del riesgo cardiovascular

Background: Although the prevalence of chronic kidney disease (CKD) is 10–14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin–creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. Materials and Methods: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20–200 mg/g (men) or 30–300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk of progression of CKD to ESRD was estimated. Results: With MDRD, 1.4% of the adult Spanish population was at moderate risk of progression to ESRD, 0.1% at high risk, and 12.3% at low risk. With CKD-EPI, the moderate risk ratio rose to 1.7% and low risk to 12.6%, but high risk remained stable. Conclusions: The addition of ACR to eGFR best classifies the population at risk for renal impairment relative to Kidney/Disease Outcomes Quality Initiative grades 3 and 4. Estimating GFR with CKD-EPI modifies the distribution of low and moderate risk.

Keywords:
Albuminuria
Keywords:
Prognosis
Keywords:
Epidemiology
Keywords:
Chronic kidney disease
Keywords:
Cardiovascular risk classification
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