低踝臂指数与快速估算肾小球滤过率下降和慢性肾脏病的发展。
Low ankle-brachial index and the development of rapid estimated GFR decline and CKD.
机构信息
National Heart, Lung, and Blood Institute's (NHLBI's) Framingham Heart Study, Framingham, MA, USA.
出版信息
Am J Kidney Dis. 2013 Feb;61(2):204-10. doi: 10.1053/j.ajkd.2012.07.009. Epub 2012 Aug 15.
BACKGROUND
Low ankle-brachial index (ABI) is associated with increases in serum creatinine level. Whether low ABI is associated with the development of rapid estimated glomerular filtration rate (eGFR) decline, stage 3 chronic kidney disease (CKD), or microalbuminuria is uncertain.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: Framingham Offspring cohort participants who attended the sixth (1995-1998) and eighth (2005-2008) examinations.
PREDICTOR
ABI, categorized as normal (>1.1 to <1.4), low-normal (>0.9 to 1.1), and low (≤0.9).
OUTCOMES
Rapid eGFR decline (eGFR decline ≥3 mL/min/1.73 m(2) per year), incident stage 3 CKD (eGFR <60 mL/min/1.73 m(2)), incident microalbuminuria.
MEASUREMENTS
GFR was estimated using the serum creatinine-based CKD-EPI (CKD Epidemiology Collaboration) equation. Urinary albumin-creatinine ratio (UACR) was determined based on spot urine samples.
RESULTS
During 9.5 years, 9.0% (232 of 2,592) experienced rapid eGFR decline and 11.1% (270 of 2,426) developed stage 3 CKD. Compared to normal ABI, low ABI was associated with 5.73-fold increased odds of rapid eGFR decline (95% CI, 2.77-11.85; P<0.001) after age, sex, and baseline eGFR adjustment; this persisted after multivariable adjustment for standard CKD risk factors (OR, 3.60; 95% CI, 1.65-7.87; P = 0.001). After adjustment for age, sex, and baseline eGFR, low ABI was associated with a 2.51-fold increased odds of stage 3 CKD (OR, 2.51; 95% CI, 1.16-5.44; P = 0.02), although this was attenuated after multivariable adjustment (OR, 1.68; 95% CI, 0.75-3.76; P = 0.2). In 1,902 free of baseline microalbuminuria, low ABI was associated with increased odds of microalbuminuria after adjustment for age, sex, and baseline UACR (OR, 2.81; 95% CI, 1.07-7.37; P = 0.04), with attenuation upon further adjustment (OR, 1.88; P = 0.1).
LIMITATIONS
Limited number of events with low ABI. Outcomes based on single serum creatinine and UACR measurements at each examination.
CONCLUSIONS
Low ABI is associated with an increased risk of rapid eGFR decline, suggesting that systemic atherosclerosis predicts a decrease in kidney function.
背景
低踝臂指数（ABI）与血清肌酐水平升高有关。低 ABI 是否与快速估算肾小球滤过率（eGFR）下降、慢性肾脏病（CKD）3 期或微量白蛋白尿的发展相关尚不确定。
研究设计
前瞻性队列研究。
地点和参与者
参加第六次（1995-1998 年）和第八次（2005-2008 年）检查的弗雷明汉后代队列参与者。
预测因子
ABI 分类为正常（>1.1 至 <1.4）、低正常（>0.9 至 1.1）和低（≤0.9）。
结局
快速 eGFR 下降（eGFR 下降≥3 mL/min/1.73 m2/年）、新发 CKD3 期（eGFR <60 mL/min/1.73 m2）、新发微量白蛋白尿。
测量
使用基于血清肌酐的 CKD-EPI（CKD 流行病学合作）方程估计 GFR。尿白蛋白/肌酐比值（UACR）根据尿液样本确定。
结果
在 9.5 年的时间里，9.0%（232/2592）经历了快速 eGFR 下降，11.1%（270/2426）发展为 CKD3 期。与正常 ABI 相比，低 ABI 与快速 eGFR 下降的风险增加 5.73 倍相关（95%CI，2.77-11.85；P<0.001），在年龄、性别和基线 eGFR 调整后仍然如此；在多变量调整标准 CKD 风险因素后（OR，3.60；95%CI，1.65-7.87；P=0.001），这种相关性仍然存在。在排除基线时无微量白蛋白尿的 1902 例患者中，在调整年龄、性别和基线 UACR 后，低 ABI 与微量白蛋白尿的风险增加相关（OR，2.81；95%CI，1.07-7.37；P=0.04），在进一步调整后相关性减弱（OR，1.88；P=0.1）。
局限性
低 ABI 相关事件数量有限。结局基于每次检查的单次血清肌酐和 UACR 测量值。
结论
低 ABI 与快速 eGFR 下降的风险增加相关，提示全身动脉粥样硬化预示着肾功能下降。
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