Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
Clin J Am Soc Nephrol. 2011 Nov;6(11):2634-41. doi: 10.2215/CJN.01990211. Epub 2011 Sep 1.
The effect of increased fluid intake on kidney function is unclear. This study evaluates the relationship between urine volume and renal decline over 6 years in a large community-based cohort.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective cohort study was undertaken in Canada from 2002 to 2008. We obtained 24-hour urine samples from adult participants with an estimated GFR (eGFR) ≥60 ml/min per 1.73 m(2) at study entry. Percentage annual change in eGFR from baseline was categorized as average decline <1% per year, between 1% and 4.9% (mild-to-moderate decline) or ≥5% (rapid decline).
2148 participants provided valid 24-hour urine samples, grouped as <1 L/d (14.5%); 1 to 1.9 L/d (51.5%); 2 to 2.9 L/d (26.3%); and ≥3 L/d (7.7%). Baseline eGFR for each category of urine volume was 90, 88, 84, and 87 ml/min per 1.73 m(2), respectively. Overall, eGFR declined by 1% per year, with 10% demonstrating rapid decline and 40% demonstrating mild-to-moderate decline. An inverse, graded relationship was evident between urine volume and eGFR decline: For each increasing category of 24-hour urine volume, percentage annual eGFR decline was progressively slower, from 1.3%, 1.0%, 0.8%, to 0.5%, respectively; P = 0.02. Compared with those with urine volume 1 to 1.9 L/d, those with urine volume ≥3 L/d were significantly less likely to demonstrate mild-to-moderate decline (adjusted odds ratio 0.66; 95% confidence interval 0.46 to 0.94) or rapid decline (adjusted odds ratio 0.46; 95% confidence interval 0.23 to 0.92); adjusted for age, gender, baseline eGFR, medication use for hypertension (including diuretics), proteinuria, diabetes, and cardiovascular disease.
In this community-based cohort, decline in kidney function was significantly slower in those with higher versus lower urine volume.
增加液体摄入对肾功能的影响尚不清楚。本研究评估了在一个大型社区队列中，6 年内尿液量与肾功下降之间的关系。
设计、地点、参与者和测量：本前瞻性队列研究于 2002 年至 2008 年在加拿大进行。我们从基线时估计肾小球滤过率（eGFR）≥60ml/min/1.73m²的成年参与者中获得 24 小时尿液样本。从基线开始，eGFR 的年变化百分比分为平均每年下降＜1%、1%至 4.9%（轻度至中度下降）或≥5%（快速下降）。
2148 名参与者提供了有效的 24 小时尿液样本，分为＜1L/d（14.5%）；1 至 1.9L/d（51.5%）；2 至 2.9L/d（26.3%）；≥3L/d（7.7%）。每个尿液量组的基线 eGFR 分别为 90、88、84 和 87ml/min/1.73m²。总的来说，eGFR 每年下降 1%，10%的人表现为快速下降，40%的人表现为轻度至中度下降。尿液量与 eGFR 下降之间存在显著的负相关关系：每增加一个 24 小时尿液量类别，eGFR 每年的下降率逐渐减慢，分别为 1.3%、1.0%、0.8%和 0.5%；P=0.02。与 1 至 1.9L/d 组相比，尿液量≥3L/d 的参与者发生轻度至中度下降（调整后的优势比 0.66；95%置信区间 0.46 至 0.94）或快速下降（调整后的优势比 0.46；95%置信区间 0.23 至 0.92）的可能性明显降低；调整年龄、性别、基线 eGFR、高血压药物治疗（包括利尿剂）、蛋白尿、糖尿病和心血管疾病。
在这个社区队列中，与较低尿液量相比，较高尿液量者的肾功能下降明显更慢。
