Bash Lori D, Erlinger Thomas P, Coresh Josef, Marsh-Manzi Jane, Folsom Aaron R, Astor Brad C
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD 21201, USA.
Am J Kidney Dis. 2009 Apr;53(4):596-605. doi: 10.1053/j.ajkd.2008.10.044. Epub 2008 Dec 24.
Inflammation and hemostasis may increase the risk of kidney function decline; however, data from prospective studies are sparse.
The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort.
SETTING & PARTICIPANTS: We used data from 14,854 middle-aged adults from 4 different US communities.
Markers of inflammation and hemostasis were examined.
OUTCOMES & MEASUREMENTS: The risk of kidney function decrease associated with these markers was studied. Glomerular filtration rate (GFR) was calculated from serum creatinine levels using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Chronic kidney disease (CKD) was defined as: (1) a decrease in estimated GFR to less than 60 mL/min/1.73 m2 from greater than 60 mL/min/1.73 m2 at baseline, or (2) a hospitalization discharge or death coded for CKD. Serum creatinine was measured at baseline and the 3- and 9-year follow-up visits. Hazard ratios (HRs) of CKD associated with increased levels of inflammatory and hemostatic variables were estimated by using multivariate Cox proportional hazards regression.
1,787 cases of CKD developed between 1987 and 2004. After adjusting for demographics, smoking, blood pressure, diabetes, lipid levels, prior myocardial infarction, antihypertensive use, alcohol use, year of marker measurement, and baseline renal function using estimated GFR, the risk of incident CKD increased with increasing quartiles of white blood cell count (HR quartile 4 versus quartile 1, 1.30; 95% confidence interval [CI], 1.12 to 1.50; P trend = 0.001), fibrinogen (HR, 1.25; 95% CI, 1.09 to 1.44; P < 0.001), von Willebrand factor (HR, 1.46; 95% CI, 1.26 to 1.68; P < 0.001), and factor VIIIc (HR, 1.39; 95% CI, 1.20 to 1.60; P < 0.001). A strong inverse association was found between serum albumin level and risk of CKD (HR, 0.63; 95% CI, 0.55 to 0.72; P < 0.001). No independent association was found with factor VIIc level.
Although we lacked a direct measure of kidney function, associations were robust to case definitions.
Markers of inflammation and hemostasis are associated with greater risk of kidney function decrease. Findings suggest that inflammation and hemostasis are antecedent pathways for CKD.
炎症和止血可能会增加肾功能下降的风险；然而，前瞻性研究的数据较为稀少。
社区动脉粥样硬化风险（ARIC）研究，一项前瞻性观察队列研究。
我们使用了来自美国4个不同社区的14,854名中年成年人的数据。
检测炎症和止血标志物。
研究了与这些标志物相关的肾功能下降风险。使用肾脏病饮食改良（MDRD）研究的四变量公式根据血清肌酐水平计算肾小球滤过率（GFR）。慢性肾脏病（CKD）定义为：（1）估算的GFR从基线时大于60 mL/min/1.73 m²降至小于60 mL/min/1.73 m²，或（2）因CKD编码的住院出院或死亡。在基线以及第3年和第9年随访时测量血清肌酐。通过多变量Cox比例风险回归估计与炎症和止血变量水平升高相关的CKD风险比（HR）。
1987年至2004年间共发生1787例CKD。在调整了人口统计学、吸烟、血压、糖尿病、血脂水平、既往心肌梗死、使用抗高血压药物、饮酒、标志物测量年份以及使用估算的GFR得出的基线肾功能后，随着白细胞计数四分位数的增加，新发CKD的风险增加（四分位数4与四分位数1相比，HR为1.30；95%置信区间[CI]为1.12至1.50；P趋势 = 0.001），纤维蛋白原（HR为1.25；95%CI为1.09至1.44；P < 0.001），血管性血友病因子（HR为1.46；95%CI为1.26至1.68；P < 0.001），以及凝血因子VIIIc（HR为1.39；95%CI为1.20至1.60；P < 0.001）。血清白蛋白水平与CKD风险之间存在强烈的负相关（HR为0.63；95%CI为0.55至0.72；P < 0.001）。未发现与凝血因子VIIc水平存在独立关联。
尽管我们缺乏对肾功能的直接测量，但这些关联对病例定义具有稳健性。
炎症和止血标志物与肾功能下降风险增加相关。研究结果表明，炎症和止血是CKD的前期途径。
