Oh Se Won, Baek Seon Ha, Kim Yong Chul, Goo Ho Suk, Heo Nam Ju, Na Ki Young, Chae Dong Wan, Kim Suhnggwon, Chin Ho Jun
Department of Internal Medicine, Seoul National University Bundang Hospital, Kyeong-Kido, Korea.
Nephrol Dial Transplant. 2012 Jun;27(6):2284-90. doi: 10.1093/ndt/gfr622. Epub 2011 Dec 1.
A recent collaborative meta-analysis by Kidney Disease: Improving Global Outcomes reported that an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) and an albumin-to-creatinine ratio of ≥ 10 mg/g were independent predictors for mortality in the general population. However, selection bias, heterogeneity of the cohorts and measurement issues could be limitations.
We analyzed the relationship of eGFR and proteinuria with mortality in the Korean general population, represented by 112,115 participants, aged ≥ 20 years, who had a voluntary health check-up with homogenous calibration of creatinine measurement from 2003 to 2009. Proteinuria (trace or more) was determined by urine dipstick.
eGFR and proteinuria were independently associated with all-cause mortality (ACM) and cardiovascular mortality (CVM), and progressive increases in risks for mortality were noted according to eGFR level and the presence of proteinuria. Compared with eGFR 90-105 mL/min/1.73 m(2), hazard ratio (HRs) for ACM were 1.60 [95% confidence interval (CI) 1.12-2.30] for eGFR 60-74 mL/min/1.73 m(2) and 3.54 (2.20-5.68) for eGFR <60 mL/min/1.73 m(2) in participants with no proteinuria. In participants with proteinuria, HRs for ACM were 2.10 (1.41-3.12) for eGFR 75-89 mL/min/1.73 m(2), 2.30 (1.50-3.53) for eGFR 60-74 mL/min/1.73 m(2) and 3.77 (2.15-6.38) for eGFR <60 mL/min/1.73 m(2). Similar findings were observed for CVM.
eGFR <75 mL/min/1.73 m(2) and urine dipstick trace or more were independent risk factors of ACM and CVM. The risks of adverse outcomes are greater in the general population with mild renal impairment or mild proteinuria.
最近由改善全球肾脏病预后组织进行的一项合作荟萃分析报告称，估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²以及白蛋白与肌酐比值≥10 mg/g是普通人群死亡率的独立预测因素。然而，选择偏倚、队列的异质性和测量问题可能存在局限性。
我们分析了2003年至2009年期间112,115名年龄≥20岁、进行了自愿健康检查且肌酐测量校准均一的韩国普通人群中，eGFR和蛋白尿与死亡率之间的关系。蛋白尿（微量或以上）通过尿试纸条测定。
eGFR和蛋白尿均与全因死亡率（ACM）和心血管死亡率（CVM）独立相关，并且根据eGFR水平和蛋白尿的存在情况，死亡率风险呈逐步增加。在无蛋白尿的参与者中，与eGFR 90 - 105 mL/min/1.73 m²相比，eGFR为60 - 74 mL/min/1.73 m²时ACM的风险比（HR）为1.60 [95%置信区间（CI）1.12 - 2.30]，eGFR <60 mL/min/1.73 m²时为3.54（2.20 - 5.68）。在有蛋白尿的参与者中，eGFR为75 - 89 mL/min/1.73 m²时ACM的HR为2.10（1.41 - 3.12），eGFR为60 - 74 mL/min/1.73 m²时为2.30（1.50 - 3.53），eGFR <60 mL/min/1.73 m²时为3.77（2.15 - 6.38）。CVM也观察到类似结果。
eGFR <75 mL/min/1.73 m²以及尿试纸条微量或以上是ACM和CVM的独立危险因素。轻度肾功能损害或轻度蛋白尿的普通人群不良结局风险更高。
