Division of General Internal Medicine, Department of Medicine, University of California-San Diego, La Jolla, CA, USA.
Am J Cardiol. 2012 Nov 15;110(10):1425-33. doi: 10.1016/j.amjcard.2012.06.053. Epub 2012 Aug 8.
Longitudinal studies of the association of estimated glomerular filtration rate (eGFR) and albuminuria with coronary artery calcium (CAC), a measure of cardiovascular disease burden, are few and contradictory. In this study, 421 community-dwelling men and women (mean age 67 years) without known heart disease had eGFRs assessed using the Modification of Diet in Renal Disease (MDRD) equation and albuminuria assessed by urine albumin/creatinine ratio (ACR) from 1997 to 1999. The mean eGFR was 78 ml/min/1.73 m(2), and the median ACR was 10 mg/g. CAC was measured using electron-beam computed tomography from 2000 to 2001, when the median total Agatston CAC score was 77; 4.5 years later, 338 participants still without heart disease underwent repeat scans (median CAC score 112); 46% of participants showed CAC progression, defined as an increase ≥2.5 mm(3) in square root-transformed CAC volume score. Cross-sectional and longitudinal logistic regression analyses showed no separate or joint association between eGFR or ACR and CAC severity or progression. In conclusion, this study does not support the use of eGFR or ACR to identify asymptomatic older adults who should be screened for subclinical cardiovascular disease with initial or sequential scanning for CAC. In the elderly, kidney function and CAC may not progress together.
关于估算肾小球滤过率（eGFR）和白蛋白尿与冠状动脉钙（CAC）的纵向研究很少且相互矛盾，CAC 是心血管疾病负担的一种衡量标准。在这项研究中，421 名居住在社区的男性和女性（平均年龄 67 岁）没有已知的心脏病，他们在 1997 年至 1999 年期间通过肾脏病饮食改良公式（MDRD）评估 eGFR，并通过尿白蛋白/肌酐比（ACR）评估白蛋白尿。平均 eGFR 为 78 ml/min/1.73 m(2)，中位数 ACR 为 10 mg/g。从 2000 年到 2001 年，使用电子束计算机断层扫描（EBCT）测量 CAC，当时中位数总 Agatston CAC 评分 77；4.5 年后，仍有 338 名无心脏病的参与者接受了重复扫描（中位数 CAC 评分 112）；46%的参与者出现 CAC 进展，定义为 CAC 体积得分的平方根增加≥2.5 mm(3)。横断面和纵向逻辑回归分析显示，eGFR 或 ACR 与 CAC 严重程度或进展之间没有单独或联合关联。总之，本研究不支持使用 eGFR 或 ACR 来识别无症状的老年成年人，这些人应该通过 CAC 的初始或连续扫描来筛查亚临床心血管疾病。在老年人中，肾脏功能和 CAC 可能不会一起进展。
