Ishani Areef, Grandits Greg A, Grimm Richard H, Svendsen Kenneth H, Collins Allan J, Prineas Ronald J, Neaton James D
Division of Nephrology (111J), Department of Medicine, Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA.
J Am Soc Nephrol. 2006 May;17(5):1444-52. doi: 10.1681/ASN.2005091012. Epub 2006 Apr 12.
The incidence of ESRD is increasing rapidly. Limited information exists regarding early markers for the development of ESRD. This study aimed to determine over 25 yr the risk for ESRD associated with proteinuria, estimated GFR (eGFR), and hematocrit in men who did not have identified kidney disease and were randomly assigned into the Multiple Risk Factor Intervention Study (MRFIT). A total of 12,866 men who were at high risk for heart disease were enrolled (1973 to 1975) and followed through 1999. Renal replacement therapy was ascertained by matching identifiers with the United States Renal Data System's data; vital status was from the National Death Index. Men who initiated renal replacement therapy or died as a result of kidney disease were deemed to have developed ESRD. Dipstick urine for proteinuria, eGFR, and hematocrit were related to development of ESRD. During 25 yr, 213 (1.7%) men developed ESRD. Predictors of ESRD were dipstick proteinuria of 1+ or > or =2+ (hazard ratio [HR] 3.1 [95% confidence interval (CI) 1.8 to 5.4] and 15.7 [95% CI 10.3 to 23.9] respectively) and an eGFR of <60 ml/min per 1.73 m(2) (HR 2.4; 95% CI 1.5 to 3.8). Correlation between eGFR and serum creatinine was 0.9; the risk for ESRD with a 1-SD difference of each was identical (HR 1.21). Bivariate analysis demonstrated a 41-fold increase in ESRD risk in those with an eGFR <60 ml/min per 1.73 m(2) and > or =2+ proteinuria (95% CI 15.2 to 71.1). There was no association between hematocrit and ESRD. Other baseline measures that independently predicted ESRD included age, cigarette smoking, BP, low HDL cholesterol, and fasting glucose. Among middle-aged men who were at high risk for cardiovascular disease but had no clinical evidence of cardiovascular disease or significant kidney disease, dipstick proteinuria and an eGFR value <60 ml/min per 1.73 m(2) were strong predictors of long-term development of ESRD. It remains unknown whether intervention for proteinuria or early identification of those with chronic kidney disease reduces the risk for ESRD.
终末期肾病（ESRD）的发病率正在迅速上升。关于ESRD发生的早期标志物的信息有限。本研究旨在确定在25年期间，未被诊断出患有肾脏疾病且被随机分配到多重危险因素干预研究（MRFIT）中的男性，蛋白尿、估算肾小球滤过率（eGFR）和血细胞比容与ESRD发生风险之间的关系。共有12866名心脏病高危男性入组（1973年至1975年），并随访至1999年。通过将标识符与美国肾脏数据系统的数据进行匹配来确定肾脏替代治疗情况；生命状态信息来自国家死亡指数。开始接受肾脏替代治疗或因肾脏疾病死亡的男性被视为发生了ESRD。蛋白尿试纸检测、eGFR和血细胞比容与ESRD的发生有关。在25年期间，213名（1.7%）男性发生了ESRD。ESRD的预测因素包括尿蛋白试纸检测为1+或≥2+（风险比[HR]分别为3.1[95%置信区间（CI）1.8至5.4]和15.7[95%CI 10.3至23.9]）以及eGFR<60 ml/(min·1.73 m²)（HR 2.4；95%CI 1.5至3.8）。eGFR与血清肌酐之间的相关性为0.9；两者每相差1个标准差时ESRD的风险相同（HR 1.21）。双变量分析显示，eGFR<60 ml/(min·1.73 m²)且蛋白尿≥2+的患者ESRD风险增加41倍（95%CI 15.2至71.1）。血细胞比容与ESRD之间无关联。其他独立预测ESRD的基线指标包括年龄、吸烟、血压、低高密度脂蛋白胆固醇和空腹血糖。在心血管疾病高危但无心血管疾病临床证据或明显肾脏疾病的中年男性中，尿蛋白试纸检测和eGFR值<60 ml/(min·1.73 m²)是ESRD长期发生的强有力预测因素。蛋白尿干预或慢性肾病患者的早期识别是否能降低ESRD风险仍不清楚。
