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估算肾小球滤过率降低和白蛋白尿升高与全因和心血管死亡率相关。高危人群队列的协作荟萃分析。

Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts.

机构信息

Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

出版信息

Kidney Int. 2011 Jun;79(12):1341-52. doi: 10.1038/ki.2010.536. Epub 2011 Feb 9.

Abstract

Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.

摘要

对高危人群进行慢性肾脏病筛查是被推荐的,但关于估算肾小球滤过率(eGFR)和白蛋白尿与全因和心血管死亡率的独立和联合关联的数据有限。为了阐明这一点,我们对 10 个队列进行了协作荟萃分析,这些队列共纳入了 266975 名因患有高血压、糖尿病或心血管疾病而具有较高慢性肾脏病风险的患者。全因死亡率风险与 eGFR 在 60-105 ml/min/1.73m² 之间并无关联,但在较低水平时会增加。与 eGFR 为 95 ml/min/1.73m² 相比,eGFR 为 60、45 和 15 ml/min/1.73m² 时的危险比分别为 1.03、1.38 和 3.11,校正白蛋白尿和心血管危险因素后。无阈值情况下,白蛋白尿与全因死亡率的对数风险呈线性相关。与白蛋白/肌酐比值为 5 相比,白蛋白/肌酐比值为 10、30 和 300 mg/g 时的校正危险比分别为 1.08、1.38 和 2.16。白蛋白尿和 eGFR 与全因死亡率呈相乘性关联,无交互作用的证据。在心血管死亡率方面也观察到了类似的关联。使用尿试纸数据的队列的结果通常与测量白蛋白/肌酐比值的队列的结果相当。因此,在高危人群中,较低的 eGFR 和较高的白蛋白尿是全因和心血管死亡率的危险因素,彼此独立,与心血管危险因素无关。

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