Muntner Paul, Vupputuri Suma, Coresh Josef, Uribarri Jaime, Fox Caroline S
Department of Community and Preventive Medicine, Mt Sinai School of Medicine, New York, New York 10029, USA.
Kidney Int. 2009 Jul;76(1):81-8. doi: 10.1038/ki.2009.76. Epub 2009 Mar 18.
Although metabolic anomalies are often seen in advanced chronic kidney disease (CKD), their presence in more mild states is unknown. We studied 6722 participants in the Third National Health and Nutrition Examination Survey, dividing them into three mutually exclusive groups consisting of those having a normal or mildly reduced estimated glomerular filtration rate (eGFR) (Modification of Diet in Renal Disease (MDRD) formula), those with normal or elevated serum cystatin C, and those with clinically relevant moderate or severely reduced eGFR (stage 3 or 4 of CKD). The prevalence of several metabolic abnormalities associated with moderate to advanced CKD was determined after standardization for age, race-ethnicity, and gender. In the absence of stage 3 or 4 CKD, patients with elevated serum cystatin C had a higher prevalence of low hemoglobin and elevated uric acid, homocysteine, phosphorus, fibrinogen, and C-reactive protein than patients with a normal serum cystatin C. Our results show that in adults with normal or mildly reduced eGFR, elevated serum cystatin C is associated with an increased prevalence of metabolic abnormalities traditionally found in moderate or severe CKD. Elevated serum cystatin C may identify patients with 'preclinical' kidney disease not detected by traditional serum creatinine measurements.
尽管代谢异常在晚期慢性肾脏病（CKD）中很常见，但在病情较轻阶段的情况尚不清楚。我们对第三次全国健康与营养检查调查中的6722名参与者进行了研究，将他们分为三个相互排斥的组，分别是估算肾小球滤过率（eGFR）正常或轻度降低（采用肾脏病饮食改良（MDRD）公式）的参与者、血清胱抑素C正常或升高的参与者以及临床上中度或重度eGFR降低（CKD 3期或4期）的参与者。在对年龄、种族和性别进行标准化后，确定了与中度至重度CKD相关的几种代谢异常的患病率。在没有CKD 3期或4期的情况下，血清胱抑素C升高的患者比血清胱抑素C正常的患者血红蛋白降低以及尿酸、同型半胱氨酸、磷、纤维蛋白原和C反应蛋白升高的患病率更高。我们的结果表明，在eGFR正常或轻度降低的成年人中，血清胱抑素C升高与传统上在中度或重度CKD中发现的代谢异常患病率增加有关。血清胱抑素C升高可能会识别出传统血清肌酐测量未检测到的“临床前”肾病患者。
