基于社区人群新发肾病的预测因素

Predictors of new-onset kidney disease in a community-based population.

作者信息

Fox Caroline S, Larson Martin G, Leip Eric P, Culleton Bruce, Wilson Peter W F, Levy Daniel

机构信息

National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass 01702, USA.

出版信息

JAMA. 2004 Feb 18;291(7):844-50. doi: 10.1001/jama.291.7.844.

DOI:10.1001/jama.291.7.844

PMID:14970063

Abstract

CONTEXT

Kidney disease is associated with an increased risk for the development of cardiovascular disease and end-stage renal disease; however, risk factors for kidney disease have not been well studied.

OBJECTIVE

To identify predictors of the development of new-onset kidney disease.

DESIGN, SETTING, AND PARTICIPANTS: A community-based, longitudinal cohort study of 2585 participants who attended both a baseline examination in 1978-1982 and a follow-up examination in 1998-2001, and who were free of kidney disease at baseline.

MAIN OUTCOME MEASURES

Kidney disease was assessed by the Modification of Diet in Renal Disease Study equation and defined by a glomerular filtration rate (GFR) in the fifth or lower percentile (< or =59.25 mL/min per 1.73 m2 in women, < or =64.25 mL/min per 1.73 m2 in men). Stepwise logistic regression was used to determine the impact of risk factors on the occurrence of new-onset kidney disease. Baseline and long-term, 12-year, averaged risk factor models were explored.

RESULTS

At baseline, there were 1223 men and 1362 women, with a mean age of 43 years, who were free of preexisting kidney disease. After a mean follow-up of 18.5 years, 244 participants (9.4%) had developed kidney disease. In multivariable models, baseline age (odds ratio [OR], 2.36 per 10-year increment; 95% confidence interval [CI], 2.00-2.78), GFR (<90 mL/min per 1.73 m2: OR, 3.01; 95% CI, 1.98-4.58; 90-119 mL/min per 1.73 m2: OR, 1.84; 95% CI, 1.16-2.93), body mass index (OR, 1.23 per 1 SD; 95% CI, 1.08-1.41), diabetes (OR, 2.60; 95% CI, 1.44-4.70), and smoking (OR, 1.42; 95% CI, 1.06-1.91) were related to the development of kidney disease. In addition to baseline age and GFR, the long-term, averaged risk factors that were predictive of kidney disease included hypertension (OR, 1.57; 95% CI, 1.17-2.12), high-density lipoprotein cholesterol level (OR, 0.80 per 1 SD; 95% CI, 0.69-0.92), and diabetes (OR, 2.38; 95% CI, 1.45-3.92). Compared with a normal GFR (> or =120 mL/min per 1.73 m2), a mildly reduced GFR (<90 mL/min per 1.73 m2) predicted a 3-fold odds of progression to kidney disease (OR, 2.95; 95% CI, 1.94-4.49).

CONCLUSIONS

Established cardiovascular disease risk factors are associated with the development of new-onset kidney disease. Patients with a mildly reduced GFR should be monitored for progression to kidney disease.

摘要

背景

肾脏疾病与心血管疾病和终末期肾病的发生风险增加相关；然而，肾脏疾病的危险因素尚未得到充分研究。

目的

确定新发肾脏疾病发生的预测因素。

设计、设置和参与者：一项基于社区的纵向队列研究，共有2585名参与者，他们在1978 - 1982年参加了基线检查，并在1998 - 2001年参加了随访检查，且基线时无肾脏疾病。

主要观察指标

通过肾病饮食改良研究方程评估肾脏疾病，并根据肾小球滤过率（GFR）定义，女性GFR处于第五百分位数或更低（≤59.25 mL/min/1.73 m²），男性GFR处于第五百分位数或更低（≤64.25 mL/min/1.73 m²）。采用逐步逻辑回归确定危险因素对新发肾脏疾病发生的影响。探索了基线和长期（12年）平均危险因素模型。

结果

基线时，有1223名男性和1362名女性，平均年龄43岁，无既往肾脏疾病。平均随访18.5年后，244名参与者（9.4%）发生了肾脏疾病。在多变量模型中，基线年龄（比值比[OR]，每增加10岁为2.36；95%置信区间[CI]，2.00 - 2.78）、GFR（<90 mL/min/1.73 m²：OR，3.01；95% CI，1.98 - 4.58；90 - 119 mL/min/1.73 m²：OR，1.84；95% CI，1.16 - 2.93）、体重指数（OR，每增加1个标准差为1.23；95% CI，1.08 - 1.41）、糖尿病（OR，2.60；95% CI，1.44 - 4.70）和吸烟（OR，1.42；95% CI，1.06 - 1.91）与肾脏疾病的发生相关。除了基线年龄和GFR外，预测肾脏疾病的长期平均危险因素包括高血压（OR，1.57；95% CI，1.17 - 2.12）、高密度脂蛋白胆固醇水平（OR，每增加1个标准差为0.80；95% CI，0.69 - 0.92）和糖尿病（OR，2.38；95% CI，1.45 - 3.92）。与正常GFR（≥120 mL/min/1.73 m²）相比，轻度降低的GFR（<90 mL/min/1.73 m²）预测进展为肾脏疾病的几率增加3倍（OR，2.95；95% CI，1.94 - 4.49）。