摘要目的 探讨在慢性肾脏病(CKD)专业门诊管理下CKD 3～5期未透析患者肾功能进展相关危险因素。方法 采取前瞻性队列研究设计，收集北京大学第一医院CKD专业门诊规律随访的CKD 3～5期未透析患者的血压、血红蛋白、钙磷代谢及蛋白尿等指标控制及肾功能的变化情况，进行肾功能进展的多因素分析。肾功能进展定义为每年估计的肾小球滤过率(eGFR)下降大于4ml·min-1·(1.73 m2)-1、开始肾脏替代治疗和(或)肾脏病相关的死亡。结果 共纳入138例患者，其中CKD 3期84例，4期36例，5期18例。进入队列时基线年龄为(56.5±16.7)岁，基线eGFR为(32.3±13.4) ml ·min-1(1.73 m2)-1，平均随访(27.1±12.1)个月。随访过程中患者平均血压(126.5±12.4)/(76.4±7.9) mm Hg;平均血红蛋白(123.4±17.6)g/L;平均钙磷乘积(45.2±7.7) mg2/dl2。分别有70例(50.7％)血压控制达标；102例(73.9％)血红蛋白控制达标；123例(89.1％)患者钙磷乘积控制达标；62例(44.9％)患者肾功能进展。多因素分析显示，随访过程中蛋白尿和血红蛋白水平与肾功能进展独立相关。结论通过CKD专业门诊的一体化治疗，能够有效控制中晚期CKD患者的各种并发症。控制蛋白尿和(或)改善贫血有利于延缓中晚期CKD患者肾功能进展。

abstractsObjective To identify the risk factors for progression of advanced chronic kidney disease (CKD) patients who were cared by nephrologists in a specific CKD outpatient management clinic.Methods A prospective monocentric cohort study was performed.CKD patients of stage 3, 4 and 5 without renal replacement treatment were followed up regularly by nephrologists in this specific CKD management clinic.Patients with established atherosclerotic renal artery stenosis (ARAS) and chronic tubulointerstitial nephritis, and those who had not been followed-up for at least 12 months before Jun.30, 2010 were excluded.Clinical and laboratory data including blood pressure (BP), proteinuria, hemoglobulin (Hb), calcium phosphate product (Ca×P) and serum creatinine were consecutively collected.The treatment regimen was also recorded.Estimated glomerular filtration rate (eGFR) was calculated with the formula modified for Chinese to evaluate the change of renal function.The progression of kidney disease was defined as initiation of renal replacement therapy, the annual decrease of eGFR＞4 ml·min-1·(1.73 m2)-1, and/or death associated with renal disease. Results A total of 138 patients were enrolled in the final analysis with 84 patients of CKD stage 3, 36 of CKD stage 4 and 18 of CKD stage 5, respectively.At the time of enrollment, patients had an average age of (56.5:±:16.7) years old with an average eGFR of (32.3±13.4) ml·min-1·(1.73 m2)-1.During a mean follow-up interval of (27.1±12.1) months, the patients were well-controlled with an average blood pressure of (126.5±12.4)/(76.4±7.9) mm Hg in 50.7％(70/138), less than or equal to 130/80 mm Hg, an average Hb of (123.8±17.1) g/L in 73.9％(102/138), above or equal to 110 g/L and an average Ca×P of (45.2±7.7) mg2/dl2 in 89.1％(123/138), less than or equal to 55 mg2/dl2.Sixty-two patients (44.9％) had progression of kidney disease. On univariate analysis, factors predicting progression were low eGFR at referral, high systolic pressure, low Hb level, high Ca×P and proteinuria during follow-up, and renin-angiotensin system inhibitors treatment did not affect the progression.After the adjustment, multivariate analysis revealed proteinuria and low Hb level were independent factors for the progression of kidney disease. Conclusions The co-morbidities of advanced CKD patients can be managed efficiently in specific CKD outpatient management clinic.Control of proteinuria and correction of anemia may be beneficial to prevent the progression of advanced CKD.