Division of Nephrology, Dept. Internal Medicine, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
PLoS One. 2013 May 27;8(5):e61119. doi: 10.1371/journal.pone.0061119. Print 2013.
Urinary albumin excretion is known to be independently associated with progression of renal and cardiovascular disease. The aim of this study was to identify predictors for progression in albuminuria in the general population.
Data were used of the first 4 screening rounds of a community-based prospective cohort study (PREVEND). Included were 5,825 subjects that at baseline had no known renal disease or macroalbuminuria. Subjects were defined as having progressive albuminuria when they belonged to the quintile of subjects with highest absolute increase in urinary albumin excretion per year and a urinary albumin excretion during the last screening in which they participated of ≥150 mg/24 h. Change in urinary albumin excretion per year was calculated as last available urinary albumin excretion minus baseline UAE divided by follow-up time.
During 9.3 years follow-up 132 subjects had progressive albuminuria. These subjects were significantly older, more often of male gender and had a worse cardiovascular risk profile. In a multivariable model, testing baseline values, significant predictors of progressive albuminuria were male gender (OR 2.23; p<0.001), age (OR 1.03; p<0.001), BMI (OR 1.06; p = 0.02) and baseline albuminuria (OR 5.71; p<0.001). Based on these findings a risk score was made to estimate a subject's risk for progressive albuminuria.
A high baseline albuminuria is by far the most important predictor of progressive albuminuria. Thus, screening for baseline albuminuria will be more important than screening for cardiovascular risk factors in order to identify subjects at risk for progressive albuminuria.
已知尿白蛋白排泄与肾脏和心血管疾病的进展独立相关。本研究旨在确定普通人群中白蛋白尿进展的预测因素。
本研究使用了一项基于社区的前瞻性队列研究（PREVEND）的前 4 次筛查轮次的数据。共纳入 5825 名基线时无已知肾脏疾病或大量白蛋白尿的受试者。当受试者属于每年尿白蛋白排泄绝对增加最高的五分位数且最后一次参加的筛查中尿白蛋白排泄≥150mg/24h 时，将其定义为白蛋白尿进展。每年尿白蛋白排泄的变化计算为最后一次可用的尿白蛋白排泄减去基线 UAE 除以随访时间。
在 9.3 年的随访中，有 132 名受试者发生了白蛋白尿进展。这些受试者年龄较大，男性居多，心血管风险状况较差。在多变量模型中，检测基线值，男性（OR 2.23；p<0.001）、年龄（OR 1.03；p<0.001）、BMI（OR 1.06；p=0.02）和基线白蛋白尿（OR 5.71；p<0.001）是白蛋白尿进展的显著预测因素。基于这些发现，制作了一个风险评分来估计受试者发生白蛋白尿进展的风险。
高基线白蛋白尿是迄今为止白蛋白尿进展最重要的预测因素。因此，为了识别发生白蛋白尿进展的风险患者，筛查基线白蛋白尿比筛查心血管危险因素更为重要。
