O'Hare Ann M, Hailpern Susan M, Pavkov Meda E, Rios-Burrows Nilka, Gupta Indra, Maynard Charles, Todd-Stenberg Jeff, Rodriguez Rudolph A, Hemmelgarn Brenda R, Saran Rajiv, Williams Desmond E
Division of Nephrology, Primary and Specialty Medicine Service Line, VA/Puget Sound Medical Center, Nephrology and Renal Dialysis Unit, Bldg 100, Room 5B113, 1660 S Columbian Way, Seattle, WA 98108, USA.
Arch Intern Med. 2010 Jun 14;170(11):930-6. doi: 10.1001/archinternmed.2010.129.
Albuminuria is associated with an increased risk of death independent of level of renal function. Whether this association is similar for adults of all ages is not known.
We examined the association between the albumin to creatinine ratio (ACR) and all-cause mortality after stratification by estimated glomerular filtration rate (eGFR) and age group in 94 934 veterans with diabetes mellitus. Cohort members had at least 1 ACR recorded in the Veterans Affairs Health Care System between October 1, 2002, and September 30, 2003, and were followed up for death through October 15, 2009.
From the youngest to the oldest age group, the prevalence of an eGFR less than 60 mL/min/1.73 m(2) ranged from 11% to 41%; microalbuminuria (ACR 30-299 mg/g) ranged from 19% to 28%; and macroalbuminuria (ACR > or =300 mg/g) ranged from 3.2% to 3.7%. Of patients with an eGFR less than 60 mL/min/1.73 m(2), 72% of those younger than 65 years, 74% of those 65 to 74 years old, and 59% of those 75 years and older had an eGFR of 45 to 59 mL/min/1.73 m(2). In all age groups, less than 35% of these patients had albuminuria (ie, ACR > or =30 mg/g). In patients 75 years and older, the ACR was independently associated with an increased risk of death at all levels of eGFR after adjusting for potential confounders. In younger age groups, this association was present at higher levels of eGFR but seemed to be attenuated at lower levels [corrected].
The ACR is independently associated with mortality at all levels of eGFR in older adults with diabetes and may be particularly helpful for risk stratification in the large group with moderate reductions in eGFR.
蛋白尿与死亡风险增加相关，且独立于肾功能水平。目前尚不清楚这种关联在所有年龄段的成年人中是否相似。
我们在94934名患有糖尿病的退伍军人中，通过估计肾小球滤过率（eGFR）和年龄组进行分层，研究了白蛋白与肌酐比值（ACR）与全因死亡率之间的关联。队列成员在2002年10月1日至2003年9月30日期间，至少在退伍军人事务医疗系统中记录了1次ACR，并随访至2009年10月15日以了解死亡情况。
从最年轻到最年长的年龄组，eGFR低于60 mL/min/1.73 m²的患病率从11%到41%不等；微量白蛋白尿（ACR 30 - 299 mg/g）的患病率从19%到28%不等；大量白蛋白尿（ACR≥300 mg/g）的患病率从3.2%到3.7%不等。在eGFR低于60 mL/min/1.73 m²的患者中，65岁以下的患者中有72%、65至74岁的患者中有74%、75岁及以上的患者中有59%的eGFR为45至59 mL/min/1.73 m²。在所有年龄组中，这些患者中白蛋白尿（即ACR≥30 mg/g）的比例均低于35%。在75岁及以上的患者中，调整潜在混杂因素后，在所有eGFR水平下，ACR均与死亡风险增加独立相关。在较年轻的年龄组中，这种关联在较高的eGFR水平时存在，但在较低水平时似乎减弱[校正后]。
在患有糖尿病的老年人中，ACR在所有eGFR水平下均与死亡率独立相关，对于eGFR中度降低的大群体进行风险分层可能特别有帮助。
