Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Am J Kidney Dis. 2010 Nov;56(5):852-60. doi: 10.1053/j.ajkd.2010.04.013.
Predictors for incident albuminuria are not well known in population-based cohorts. The purpose of this study is to identify predictors of incident albuminuria in an unselected middle-aged population.
Observational cohort study.
SETTING & PARTICIPANTS: Framingham Offspring Study participants who attended both the sixth (baseline; 1995-1998) and eighth (2005-2008) examination cycles.
Standard clinical predictors were used. Predictors of incident albuminuria were identified using stepwise logistic regression analysis with age and sex forced into the model.
OUTCOMES & MEASUREMENTS: Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥ 17 mg/g (men) or ≥ 25 mg/g (women). Individuals with albuminuria at baseline were excluded.
1,916 participants were available for analysis (mean age, 56 years; 54% women). Albuminuria developed in 10.0% of participants (n = 192) during 9.5 years. Age (OR, 2.09; P < 0.001), baseline diabetes (OR, 1.93; P = 0.01), smoking (OR, 2.09; P < 0.001), and baseline log UACR (OR per 1-SD increase in log UACR, 1.56; P < 0.001) were associated with incident albuminuria in a stepwise model. An inverse relationship with female sex (OR, 0.53; P < 0.001) and high-density lipoprotein (HDL) cholesterol level (OR, 0.80; P = 0.007) also was observed. Results were similar when participants with baseline chronic kidney disease (n = 102), defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2), were excluded from the model. Age, male sex, low HDL cholesterol level, smoking, and log UACR continued to be associated with incident albuminuria when baseline diabetes (n = 107) was excluded. Age, male sex, and log UACR correlated with incident albuminuria after participants with baseline hypertension were excluded (n = 651).
Causality may not be inferred because of the observational nature of the study. One-third of participants did not return for follow-up, potentially attenuating the observed risks of albuminuria.
The known cardiovascular risk factors of increasing age, male sex, diabetes, smoking, low HDL cholesterol level, and albuminuria within the reference range are correlates of incident albuminuria in the general population.
在基于人群的队列研究中，白蛋白尿的预测因素尚不清楚。本研究的目的是在未选择的中年人群中确定白蛋白尿的预测因素。
观察性队列研究。
参加了第六次（基线；1995-1998 年）和第八次（2005-2008 年）检查周期的弗雷明汉后代研究参与者。
使用标准临床预测因素。使用逐步逻辑回归分析确定白蛋白尿的预测因素，年龄和性别强行纳入模型。
1916 名参与者可用于分析（平均年龄 56 岁；54%为女性）。在 9.5 年内，有 10.0%（n=192）的参与者发生了白蛋白尿。年龄（OR，2.09；P<0.001）、基线糖尿病（OR，1.93；P=0.01）、吸烟（OR，2.09；P<0.001）和基线 log UACR（OR 每 1-SD 增加 log UACR，1.56；P<0.001）在逐步模型中与白蛋白尿相关。与女性性别（OR，0.53；P<0.001）和高密度脂蛋白（HDL）胆固醇水平（OR，0.80；P=0.007）呈负相关。当从模型中排除基线慢性肾脏病（n=102）患者（定义为估计肾小球滤过率<60 mL/min/1.73 m2）时，结果相似。当排除基线糖尿病（n=107）患者时，年龄、男性、低 HDL 胆固醇水平、吸烟和 log UACR 与白蛋白尿的发生仍相关。当排除基线高血压患者（n=651）时，年龄、男性和 log UACR 与白蛋白尿的发生相关。
由于研究的观察性质，不能推断因果关系。三分之一的参与者未进行随访，可能会降低观察到的白蛋白尿风险。
在一般人群中，已知的心血管危险因素，如年龄增长、男性、糖尿病、吸烟、低 HDL 胆固醇水平和白蛋白尿参考范围内的白蛋白尿，与白蛋白尿的发生有关。
