Department of Medicine, University of Calgary, Calgary, AB, Canada.
Lancet. 2010 Dec 18;376(9758):2096-103. doi: 10.1016/S0140-6736(10)61271-8. Epub 2010 Nov 20.
Low values of estimated glomerular filtration rate (eGFR) predispose to acute kidney injury, and proteinuria is a marker of kidney disease. We aimed to investigate how eGFR and proteinuria jointly modified the risks of acute kidney injury and subsequent adverse clinical outcomes.
We did a cohort study of 920,985 adults residing in Alberta, Canada, between 2002 and 2007. Participants not needing chronic dialysis at baseline and with at least one outpatient measurement of both serum creatinine concentration and proteinuria (urine dipstick or albumin-creatinine ratio) were included. We assessed hospital admission with acute kidney injury with validated administrative codes; other outcomes were all-cause mortality and a composite renal outcome of end-stage renal disease or doubling of serum creatinine concentration.
During median follow-up of 35 months (range 0-59 months), 6520 (0·7%) participants were admitted with acute kidney injury. In those with eGFR 60 mL/min per 1·73 m(2) or greater, the adjusted risk of admission with this disorder was about 4 times higher in those with heavy proteinuria measured by dipstick (rate ratio 4·4 vs no proteinuria, 95% CI 3·7-5·2). The adjusted rates of admission with acute kidney injury and kidney injury needing dialysis remained high in participants with heavy dipstick proteinuria for all values of eGFR. The adjusted rates of death and the composite renal outcome were also high in participants admitted with acute kidney injury, although the rise associated with this injury was attenuated in those with low baseline eGFR and heavy proteinuria.
These findings suggest that information on proteinuria and eGFR should be used together when identifying people at risk of acute kidney injury, and that an episode of acute kidney injury provides further long-term prognostic information in addition to eGFR and proteinuria.
The study was funded by an interdisciplinary team grant from Alberta Heritage Foundation for Medical Research.
估算肾小球滤过率（eGFR）值较低易导致急性肾损伤，蛋白尿是肾脏疾病的标志物。本研究旨在探讨 eGFR 和蛋白尿联合如何改变急性肾损伤和随后不良临床结局的风险。
我们进行了一项队列研究，纳入了 2002 年至 2007 年间居住在加拿大艾伯塔省的 920985 名成年人。纳入标准为基线时无需接受慢性透析且至少有一次血清肌酐浓度和蛋白尿（尿试纸或白蛋白-肌酐比值）的门诊测量值。我们使用验证后的行政代码评估急性肾损伤住院患者；其他结局为全因死亡率和终末期肾病或血清肌酐浓度翻倍的复合肾脏结局。
中位随访 35 个月（0-59 个月）期间，6520 名（0.7%）参与者因急性肾损伤住院。在 eGFR 为 60 mL/min/1.73 m²或更高的患者中，尿试纸法检测到大量蛋白尿患者的这种疾病的校正风险约为无蛋白尿患者的 4 倍（率比 4.4，95%CI 3.7-5.2）。对于所有 eGFR 值的大量尿试纸蛋白尿患者，急性肾损伤住院的校正发生率和需要透析的肾损伤发生率仍然较高。虽然与急性肾损伤相关的死亡率和复合肾脏结局的升高在急性肾损伤住院患者中也较高，但在基线 eGFR 和大量蛋白尿较低的患者中，这种损伤的关联减弱。
这些发现表明，在识别急性肾损伤风险人群时，应同时使用蛋白尿和 eGFR 信息，急性肾损伤除 eGFR 和蛋白尿外还提供了额外的长期预后信息。
该研究由艾伯塔省医学研究遗产基金会的跨学科团队资助。
