Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Hypertens Res. 2013 Sep;36(9):807-23. doi: 10.1038/hr.2013.44. Epub 2013 May 23.
Microalbuminuria is an early sign of nephropathy and an independent predictor of end-stage renal disease. The purpose of this study was to assess microalbuminuria prevalence and its contributing factors in Korean hypertensive patients. This cross-sectional study enrolled male and female patients of ≥35 years old with an essential hypertension diagnosis as made by 841 physicians in primary care clinics and 17 in general hospitals in the Republic of Korea between November 2008 and July 2009. To assess microalbuminuria prevalence, urine albumin/creatinine ratio (UACR) was measured in patients with a positive dipstick test. Of the 40,473 enrolled patients, 5713 (14.1%) had a positive dipstick test. Of 5393 patients with a positive dipstick test and valid UACR values, 2657 (6.6%) had significantly elevated UACR (≥30 μg mg(-1)), 2158 (5.4%) had microalbuminuria (30 μg mg(-1)≤UACR <300 μg mg(-1)) and 499 (1.2%) had macroalbuminuria (UACR ≥300 μg mg(-1)). Based on multivariate analysis, independent factors associated with elevated UACR included low adherence to antihypertensive medication (23% higher; P=0.042), poorly controlled blood pressure (BP; 38% higher for systolic BP/diastolic BP ≥130 mm Hg/≥80 mm Hg; P<0.001), obesity (47% higher for body mass index (BMI) ≥25.0 kg m(-2); P<0.001), age (17% lower and 58% higher for age categories 35-44 years (P=0.043) and >75 years (P<0.001), respectively) and a prior history of diabetes (151% higher; P<0.001) and kidney-related disease (71% higher; P<0.001). The prevalences of elevated UACR and microalbuminuria were 6.6% and 5.4%, respectively. Age, increased BMI, presence of comorbidities, poor medication adherence and inadequately controlled BP were independent predictors of elevated UACR after controlling for potential confounders.
微量白蛋白尿是肾病的早期征象，也是终末期肾病的独立预测因子。本研究旨在评估韩国高血压患者微量白蛋白尿的患病率及其相关因素。本横断面研究纳入了 2008 年 11 月至 2009 年 7 月期间，由 841 名初级保健诊所医生和 17 名综合医院医生诊断为原发性高血压的≥35 岁男性和女性患者。为评估微量白蛋白尿的患病率，对尿白蛋白/肌酐比值（UACR）阳性的患者进行了检测。在纳入的 40473 名患者中，有 5713 名（14.1%）尿试纸检测呈阳性。在 5393 名尿试纸检测阳性且 UACR 值有效的患者中，有 2657 名（6.6%）UACR 显著升高（≥30μgmg(-1)），2158 名（5.4%）有微量白蛋白尿（30μgmg(-1)≤UACR <300μgmg(-1)），499 名（1.2%）有大量白蛋白尿（UACR≥300μgmg(-1)）。基于多变量分析，与 UACR 升高相关的独立因素包括：降压药物治疗依从性低（23%；P=0.042）、血压（BP）控制不佳（收缩压/舒张压≥130mmHg/≥80mmHg，38%；P<0.001）、肥胖（BMI≥25.0kgm(-2)，47%；P<0.001）、年龄（35-44 岁（P=0.043）和>75 岁（P<0.001）年龄组分别低 17%和高 58%）、既往糖尿病史（151%；P<0.001）和肾脏相关疾病史（71%；P<0.001）。UACR 升高和微量白蛋白尿的患病率分别为 6.6%和 5.4%。在控制潜在混杂因素后，年龄、BMI 增加、合并症、药物治疗依从性差和 BP 控制不充分是 UACR 升高的独立预测因子。
