台湾中年劳动人口的全因死亡率、心血管疾病死亡率及肾小球滤过率降低情况
Mortality risks for all causes and cardiovascular diseases and reduced GFR in a middle-aged working population in Taiwan.
作者信息
Cheng Ting-Yuan David, Wen Sung-Feng, Astor Brad C, Tao Xuguang Grant, Samet Jonathan M, Wen Chi Pang
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Am J Kidney Dis. 2008 Dec;52(6):1051-60. doi: 10.1053/j.ajkd.2008.05.030. Epub 2008 Aug 15.
BACKGROUND
Effects of decreased estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) mortality are uncertain in Chinese general populations.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: 17,026 adults 50 years and older in Taiwan. A subset of 7,968 had repeated measurements.
PREDICTOR
Decreased eGFR and its progression. eGFR was calculated from serum creatinine level by using the Modification of Diet in Renal Disease Study equation.
OUTCOMES
Mortality from all causes and CVD, including coronary heart disease (CHD) and stroke, from the National Death Registry.
MEASUREMENTS
Hazard ratios (HRs) and Kaplan-Meier survival curves were calculated for participants with a moderate to severe decrease in eGFR (<60 mL/min/1.73 m(2)) compared with those with normal eGFR (> or =90 mL/min/1.73 m(2)). HR of a rapid decrease (> or =20%) in eGFR was also calculated.
RESULTS
Mean age of all participants was 57.2 +/- 5.2 (SD) years. We observed 1,682 deaths in 15 years of follow-up. Participants with a moderate to severe decrease in eGFR had increased HRs for mortality from all causes (1.44; 95% confidence interval [CI], 1.22 to 1.70), CVD (1.90; 95% CI, 1.36 to 2.65), CHD (2.07; 95% CI, 1.26 to 3.41), and stroke (2.16; 95% CI, 1.29 to 3.62) after adjusting for confounders. Decreased eGFR was associated with ischemic stroke, but not hemorrhagic stroke. No significant interaction between decreased eGFR and anemia, diabetes, or smoking was found. There were 660 participants with a 20% or greater decrease in eGFR from baseline during 18 months of follow-up. They had increased HRs for all causes (1.45; 95% CI, 1.13 to 1.86), CVD (2.48; 95% CI, 1.58 to 3.89), CHD (2.14; 95% CI, 1.07 to 4.29), and stroke (2.79; 95% CI, 1.45 to 5.36) compared with those with less than a 20% decrease in eGFR during the same period.
LIMITATIONS
Data for proteinuria were not available. Creatinine assay was not calibrated.
CONCLUSIONS
A moderate to severe or fast decrease in eGFR was associated with all-cause and CVD mortality in this ethnic Chinese cohort.
背景
在中国普通人群中，估算肾小球滤过率（eGFR）降低对心血管疾病（CVD）死亡率的影响尚不确定。
研究设计
前瞻性队列研究。
研究地点与参与者
台湾地区17026名50岁及以上成年人。其中7968人有重复测量数据。
预测因素
eGFR降低及其进展情况。eGFR通过使用肾脏病饮食改良研究方程根据血清肌酐水平计算得出。
研究结果
通过国家死亡登记处获取全因死亡率和CVD死亡率，包括冠心病（CHD）和中风死亡率。
测量指标
计算eGFR中度至重度降低（<60 mL/min/1.73 m²）的参与者与eGFR正常（≥90 mL/min/1.73 m²）的参与者相比的风险比（HRs）和Kaplan-Meier生存曲线。还计算了eGFR快速降低（≥20%）的HR。
结果
所有参与者的平均年龄为57.2±5.2（标准差）岁。在15年的随访中，我们观察到1682例死亡。在校正混杂因素后，eGFR中度至重度降低的参与者全因死亡率（1.44；95%置信区间[CI]，1.22至1.70）、CVD死亡率（1.90；95%CI，1.36至2.65）、CHD死亡率（2.07；95%CI，1.26至3.41）和中风死亡率（2.16；95%CI，1.29至3.62）均升高。eGFR降低与缺血性中风相关，但与出血性中风无关。未发现eGFR降低与贫血、糖尿病或吸烟之间存在显著交互作用。在18个月的随访期间，有660名参与者的eGFR较基线降低了20%或更多。与同期eGFR降低幅度小于20%的参与者相比，他们的全因死亡率（1.45；95%CI，1.13至1.86）、CVD死亡率（2.48；95%CI，1.58至3.89）、CHD死亡率（2.14；95%CI，1.07至4.29）和中风死亡率（2.79；95%CI，1.45至5.36）均升高。
局限性
无法获取蛋白尿数据。肌酐检测未进行校准。
结论
在这个华裔队列中，eGFR中度至重度降低或快速降低与全因死亡率和CVD死亡率相关。
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