McCullough Peter A, Li Suying, Jurkovitz Claudine T, Stevens Leslie, Collins Alan J, Chen Shu-Cheng, Norris Keith C, McFarlane Samy, Johnson Bruce, Shlipak Michael G, Obialo Chamberlain I, Brown Wendy W, Vassalotti Joseph, Whaley-Connell Adam T, Brenner Robert M, Bakris George L
Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Am Heart J. 2008 Aug;156(2):277-83. doi: 10.1016/j.ahj.2008.02.024. Epub 2008 Jun 4.
Chronic kidney disease (CKD) is recognized as an independent cardiovascular disease (CVD) risk state, particularly in the elderly, and has been defined by levels of estimated glomerular filtration rate (eGFR) and markers of kidney damage. The relationship between CKD and CVD in younger and middle-aged adults has not been fully explored.
Community volunteers completed surveys regarding past medical events and underwent blood pressure and laboratory testing. Chronic kidney disease was defined as an eGFR <60 mL x min(-1) x 1.73 m(-2) or urine albumin-creatinine ratio (ACR) > or =30 mg/g. Premature CVD was defined as self-reported myocardial infarction or stroke at <55 years of age in men and <65 years of age in women. Mortality was ascertained by linkage to national data systems.
Of 31 417 participants, the mean age was 45.1 +/- 11.2 years, 75.5% were female, 36.8% African American, and 21.6% had diabetes. A total of 20.6% were found to have CKD, with the ACR and eGFR being the dominant positive screening tests in the younger and older age deciles, respectively. The prevalences of premature myocardial infarction (MI), stroke, or death, and the composite were 5.3%, 4.7%, 0.8%, 9.2%, and 2.5%, 2.2%, 0.2%, 4.2% for those with and without CKD, respectively (P < .0001 for composite). Multivariable analysis found CKD (OR 1.44, 95% CI 1.27-1.63), age (OR 1.05 [per year], 95% CI 1.04-1.06), hypertension (OR 1.61, 95% CI 1.40-1.84), diabetes (OR 2.03, 95% CI 1.79-2.29), smoking (OR 1.91, 95% CI 1.66-2.21), and less than high school education (OR 1.59, 95% CI 1.37-1.85) as the most significantly associated factors for premature CVD or death (all P < .0001). Survival analysis found those with premature MI or stroke and CKD had the poorest short-term survival over the next 3 years after screening.
Chronic kidney disease is an independent predictor of MI, stroke, and death among men and women younger than age 55 and 65 years, respectively. These data suggest the biologic changes that occur with kidney failure promote CVD at an accelerated rate that cannot be fully explained by conventional risk factors or older age. Screening for CKD by using both the ACR and eGFR can identify younger and middle-aged individuals at high risk for premature CVD and near-term death.
慢性肾脏病（CKD）被认为是一种独立的心血管疾病（CVD）风险状态，在老年人中尤为如此，并且已根据估算肾小球滤过率（eGFR）水平和肾脏损伤标志物来定义。CKD与中青年成人CVD之间的关系尚未得到充分探讨。
社区志愿者完成了关于既往医疗事件的调查，并接受了血压测量和实验室检测。慢性肾脏病被定义为eGFR<60 mL·min⁻¹·1.73 m⁻²或尿白蛋白肌酐比值（ACR）≥30 mg/g。过早发生的CVD被定义为男性在55岁之前、女性在65岁之前自我报告的心肌梗死或中风。通过与国家数据系统的关联来确定死亡率。
在31417名参与者中，平均年龄为45.1±11.2岁，75.5%为女性，36.8%为非裔美国人，21.6%患有糖尿病。总共发现20.6%的人患有CKD，ACR和eGFR分别是年轻和老年十分位数人群中主要的阳性筛查指标。患有和未患有CKD的人群中，过早发生心肌梗死（MI）、中风或死亡以及综合事件的患病率分别为5.3%、4.7%、0.8%、9.2%和2.5%、2.2%、0.2%、4.2%（综合事件P<0.0001）。多变量分析发现，CKD（比值比[OR]1.44，95%置信区间[CI]1.27 - 1.63）、年龄（OR 1.05[每年]，95%CI 1.04 - 1.06）、高血压（OR 1.61，95%CI 1.40 - 1.84）、糖尿病（OR 2.03，95%CI 1.79 - 2.29）、吸烟（OR 1.91，95%CI 1.66 - 2.21）以及高中以下学历（OR 1.59，95%CI 1.37 - 1.85）是过早发生CVD或死亡的最显著相关因素（所有P<0.0001）。生存分析发现，患有过早MI或中风且患有CKD的患者在筛查后的接下来3年中短期生存率最差。
慢性肾脏病分别是55岁以下男性和65岁以下女性发生MI、中风和死亡的独立预测因素。这些数据表明，肾衰竭时发生的生物学变化会加速CVD的发展，而传统风险因素或老年并不能完全解释这种现象。同时使用ACR和eGFR筛查CKD可以识别出过早发生CVD和近期死亡风险较高的中青年个体。
