高尿酸血症作为筛查队列中发生终末期肾病风险因素的意义。

Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort.

作者信息

Iseki Kunitoshi, Ikemiya Yoshiharu, Inoue Taku, Iseki Chiho, Kinjo Kozen, Takishita Shuichi

机构信息

Dialysis Unit and Third Department of Internal Medicine, University Hospital of The Ryukyus, Okinawa, Japan.

出版信息

Am J Kidney Dis. 2004 Oct;44(4):642-50.

PMID:15384015

Abstract

BACKGROUND

Uric acid may be a true mediator of renal disease and progression. However, epidemiological evidence for the significance of serum uric acid levels on the risk for developing end-stage renal disease (ESRD) is scarce in a setting of community-based screening.

METHODS

Participants in a 1993 mass screening conducted by the Okinawa General Health Maintenance Association in Okinawa, Japan, were investigated: 48,177 screenees (22,949 men, 25,228 women) older than 20 years for whom serum uric acid data were available were studied. All dialysis patients treated in Okinawa were independently registered in the Okinawa Dialysis Study registry. Participants in the 1993 screening who later entered a dialysis program were identified by using 2 computer registries. The cumulative incidence of ESRD was calculated according to quartiles of baseline serum uric acid levels for each sex. The significance of hyperuricemia (serum uric acid level > or = 7.0 mg/dL [> or =416 micromol/L] in men and > or = 6.0 mg/dL [> or =357 micromol/L] in women) for the risk for developing ESRD was evaluated by means of the Cox model after adjusting for age, blood pressure, body mass index, proteinuria, hematocrit, and total cholesterol, triglyceride, fasting blood glucose, and serum creatinine levels.

RESULTS

Mean serum uric acid level was 6.4 +/- 1.4 (SD) mg/dL (381 micromol/L) in men and 4.8 +/- 1.1 mg/dL (286 micromol/L) in women. Prevalences of hyperuricemia were 31.9% in men and 13.6% in women. By the end of 2000, a total of 103 screenees (53 men, 50 women) entered dialysis programs. Calculated incidences of ESRD per 1,000 screenees were 1.22 for men without hyperuricemia and 4.64 for men with hyperuricemia and 0.87 for women without hyperuricemia and 9.03 for women with hyperuricemia. Adjusted hazard ratios for hyperuricemia were 2.004 (95% confidence interval, 0.904 to 4.444; P = not significant) in men and 5.770 (95% confidence interval, 2.309 to 14.421; P = 0.0002) in women.

CONCLUSION

Screenees with hyperuricemia were associated with a greater incidence of ESRD. Hyperuricemia (serum uric acid > or = 6.0 mg/dL [> or =357 micromol/L]) was an independent predictor of ESRD in women. Strategies to control serum uric acid levels in the normal range may reduce the population burden of ESRD.

摘要

背景

尿酸可能是肾脏疾病及其进展的真正介质。然而，在基于社区筛查的情况下，关于血清尿酸水平对终末期肾病（ESRD）发病风险影响的流行病学证据尚少。

方法

对1993年日本冲绳综合健康维护协会在冲绳进行的大规模筛查参与者进行调查：研究了48177名20岁以上且有血清尿酸数据的受检者（男性22949名，女性25228名）。冲绳所有接受透析治疗的患者均独立登记在冲绳透析研究登记处。通过两个计算机登记处确定1993年筛查中后来进入透析项目的参与者。根据性别将基线血清尿酸水平分为四分位数，计算ESRD的累积发病率。在调整年龄、血压、体重指数、蛋白尿、血细胞比容以及总胆固醇、甘油三酯、空腹血糖和血清肌酐水平后，采用Cox模型评估高尿酸血症（男性血清尿酸水平≥7.0mg/dL[≥416μmol/L]，女性≥6.0mg/dL[≥357μmol/L]）对ESRD发病风险的影响。

结果

男性平均血清尿酸水平为6.4±1.4（标准差）mg/dL（381μmol/L），女性为4.8±1.1mg/dL（286μmol/L）。男性高尿酸血症患病率为31.9%，女性为13.6%。到2000年底，共有103名受检者（男性53名，女性50名）进入透析项目。每1000名受检者中，男性非高尿酸血症者ESRD发病率为1.22，高尿酸血症者为4.64；女性非高尿酸血症者为0.87，高尿酸血症者为9.03。高尿酸血症的校正风险比在男性中为2.004（95%置信区间，0.904至4.444；P=无统计学意义），在女性中为5.770（95%置信区间，2.309至14.421；P=0.0002）。