Tufts Medical Center and Tufts University School of Medicine, University of Washington, Seattle, USA.
Nephrol Dial Transplant. 2010 May;25(5):1560-7. doi: 10.1093/ndt/gfp646. Epub 2009 Dec 15.
Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known.
We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m(2)); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m(2)); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m(2)). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure.
One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk.
Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.
肾脏疾病是老年人死亡和心血管疾病的一个风险因素，但白蛋白尿和半胱氨酸蛋白酶抑制剂 C（一种新的肾小球滤过标志物）的单独和联合作用尚不清楚。
我们在心血管健康研究中对 3291 名老年人进行了中位随访 8.3 年的研究，检测了这些标志物与死亡率和心血管结局之间的关系。使用尿白蛋白/肌酐比值（ACR）、半胱氨酸蛋白酶抑制剂 C 和肾脏病饮食改良试验估计肾小球滤过率（eGFR）来评估肾脏疾病。我们根据是否存在微量白蛋白尿（ACR>30mg/g）和正常肾功能（半胱氨酸蛋白酶 C<1.0mg/L 和 eGFR>60mL/min/1.73m2）、亚临床肾脏疾病（半胱氨酸蛋白酶 C 水平>1.0mg/L 但 eGFR>60mL/min/1.73m2）和慢性肾脏病（eGFR<60mL/min/1.73m2）定义亚组。使用 Cox 比例风险模型来研究这六个亚组与全因或心血管死亡率、心肌梗死和心力衰竭之间的关系。
1150 人（34.9%）具有正常肾功能（12.2%有微量白蛋白尿），1518 人（46.1%）有亚临床肾脏疾病（17.9%有微量白蛋白尿），622 人（18.9%）有慢性肾脏病（47%有微量白蛋白尿）。调整后，亚临床肾脏疾病或微量白蛋白尿的存在与死亡率风险增加 50%以上相关；两者同时存在与死亡率风险增加 2.4 倍相关。同时患有慢性肾脏病和微量白蛋白尿的人风险最高，死亡率风险几乎增加了 4 倍。
半胱氨酸蛋白酶 C 和白蛋白尿的升高很常见，可识别老年人的不同亚组，且为独立的、分级的心血管疾病和死亡率危险因素。
