Nitsch Dorothea, Felber Dietrich Denise, von Eckardstein Arnold, Gaspoz Jean-Michel, Downs Sara H, Leuenberger Philippe, Tschopp Jean-Marie, Brändli Otto, Keller Roland, Gerbase Margaret W, Probst-Hensch Nicole M, Stutz Elisabeth Zemp, Ackermann-Liebrich Ursula
Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Nephrol Dial Transplant. 2006 Apr;21(4):935-44. doi: 10.1093/ndt/gfk021. Epub 2006 Jan 3.
Impaired renal function is evolving as an independent marker of the risk of cardiovascular morbidity and mortality. Little is known about the prevalence of impaired renal function and its relationship to cardiovascular risk factors in the Swiss general population.
SAPALDIA comprises a random sample of the Swiss population established in 1991, originally to investigate the health effects of long-term exposure to air pollution. Participants were reassessed in 2002/3 and blood measurements were obtained (n = 6317). Renal function was estimated using the Cockcroft-Gault equation and the modified MDRD (four-component) equation incorporating age, race, gender and serum creatinine level.
The estimated prevalence of impaired renal function [estimated glomerular filtration rate <60 ml/min/1.73 m(2)] differed substantially between men and women, particularly at higher ages, and amounted to 13% [95% confidence interval (CI) 10-16%] and 36% (95% CI 32-40%) in men and women, respectively, of 65 years or older. Smoking, obesity, blood lipid levels, high systolic blood pressure and hyperuricaemia were all more common in men when compared with women. These cardiovascular risk factors were also associated independently with creatinine in both women and men. Women were less likely to receive cardiovascular drugs, in particular angiotensin-converting enzyme inhibitors and beta-blockers, when compared with men of the same age.
Moderate renal impairment seems to be prevalent in the general population, with an apparent excess in females which is not explained by conventional cardiovascular risk factors. The unexpected finding questions the validity of the prediction equations, in particular in females.
肾功能受损正逐渐成为心血管疾病发病和死亡风险的一个独立标志物。关于瑞士普通人群中肾功能受损的患病率及其与心血管危险因素的关系，人们知之甚少。
瑞士成人空气污染与肺部疾病队列研究（SAPALDIA）包含1991年建立的瑞士人群随机样本，最初旨在调查长期暴露于空气污染对健康的影响。2002/2003年对参与者进行了重新评估并采集了血液样本（n = 6317）。使用Cockcroft-Gault方程和纳入年龄、种族、性别及血清肌酐水平的改良MDRD（四变量）方程估算肾功能。
肾功能受损（估算肾小球滤过率<60 ml/min/1.73 m²）的估算患病率在男性和女性之间存在显著差异，尤其是在较高年龄组，65岁及以上男性和女性的患病率分别为13% [95%置信区间（CI）10 - 16%]和36%（95% CI 32 - 40%）。与女性相比，吸烟、肥胖、血脂水平、高收缩压和高尿酸血症在男性中更为常见。这些心血管危险因素在女性和男性中也均与肌酐独立相关。与同龄男性相比，女性接受心血管药物治疗的可能性较小，尤其是血管紧张素转换酶抑制剂和β受体阻滞剂。
中度肾功能损害在普通人群中似乎普遍存在，女性患病率明显更高，而传统心血管危险因素无法解释这一现象。这一出乎意料的发现对预测方程的有效性提出了质疑，尤其是在女性中。
