School of Medicine, University of California, San Francisco, CA.
Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA.
Am J Kidney Dis. 2014 Jul;64(1):49-56. doi: 10.1053/j.ajkd.2014.01.432. Epub 2014 Mar 18.
Kidney damage and reduced kidney function are potent risk factors for heart failure, but existing studies are limited to assessing albuminuria or estimated glomerular filtration rate (eGFR). We evaluated the associations of levels of urinary biomarkers of kidney tubular injury (interleukin 18 [IL-18] and kidney injury molecule 1 [KIM-1]) with future risk of heart failure.
Retrospective cohort study.
SETTING & PARTICIPANTS: 2,917 participants without heart failure in the Health, Aging, and Body Composition (Health ABC) cohort.
Ratios of urine KIM-1, IL-18, and albumin to creatinine (KIM-1:Cr, IL-18:Cr, and ACR, respectively).
Incident heart failure over a median follow-up of 12 years.
Median values of each marker at baseline were 812 (IQR, 497-1,235)pg/mg for KIM-1:Cr, 31 (IQR, 19-56)pg/mg for IL-18:Cr, and 8 (IQR, 5-19) mg/g for ACR. 596 persons developed heart failure during follow-up. The top quartile of KIM-1:Cr was associated with risk of incident heart failure after adjustment for baseline eGFR, heart failure risk factors, and ACR (HR, 1.32; 95% CI, 1.02-1.70) in adjusted multivariate proportional hazards models. The top quartile of IL-18:Cr also was associated with heart failure in a model adjusted for risk factors and eGFR (HR, 1.35; 95% CI, 1.05-1.73), but was attenuated by adjustment for ACR (HR, 1.15; 95% CI, 0.89-1.48). The top quartile of ACR had a stronger adjusted association with heart failure (HR, 1.96; 95% CI, 1.53-2.51).
Generalizability to other populations is uncertain.
Higher urine KIM-1 concentrations were associated independently with incident heart failure risk, although the associations of higher ACR were of stronger magnitude.
肾脏损伤和肾功能降低是心力衰竭的有力危险因素，但现有研究仅限于评估白蛋白尿或估算肾小球滤过率（eGFR）。我们评估了尿肾管状损伤生物标志物（白细胞介素 18 [IL-18]和肾损伤分子 1 [KIM-1]）水平与未来心力衰竭风险之间的关系。
回顾性队列研究。
无心力衰竭的 2917 名健康、衰老和身体成分（健康 ABC）队列参与者。
尿液 KIM-1、IL-18 和白蛋白与肌酐的比值（KIM-1：Cr、IL-18：Cr 和 ACR，分别）。
中位随访 12 年后发生心力衰竭。
基线时每个标志物的中位数值分别为 KIM-1：Cr 为 812（IQR，497-1235）pg/mg，IL-18：Cr 为 31（IQR，19-56）pg/mg，ACR 为 8（IQR，5-19）mg/g。在随访期间，有 596 人发生心力衰竭。在调整基线 eGFR、心力衰竭危险因素和 ACR 后，KIM-1：Cr 的四分位间距最高与新发心力衰竭的风险相关（调整后的多变量比例风险模型中的 HR，1.32；95%CI，1.02-1.70）。在调整危险因素和 eGFR 后的模型中，IL-18：Cr 的四分位间距最高也与心力衰竭相关（HR，1.35；95%CI，1.05-1.73），但通过调整 ACR 后减弱（HR，1.15；95%CI，0.89-1.48）。ACR 的四分位间距最高与心力衰竭的调整关联更强（HR，1.96；95%CI，1.53-2.51）。
推广到其他人群的结果不确定。
尿液 KIM-1 浓度升高与心力衰竭风险的独立相关，尽管 ACR 升高的相关性更大。
