McMahon Gearoid M, Preis Sarah R, Hwang Shih-Jen, Fox Caroline S
National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts; Renal Division and.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
J Am Soc Nephrol. 2014 Nov;25(11):2633-41. doi: 10.1681/ASN.2013070750. Epub 2014 Jun 26.
Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present ≥30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR≤60 ml/min per 1.73 m2) at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDLc (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable ≥30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.
早期识别慢性肾脏病（CKD）风险因素可能有助于改变风险因素并预防CKD进展。我们在一项病例对照研究中，利用弗雷明汉后代研究的数据，调查了CKD诊断前≥30年就存在风险因素的假设。在第6、7和8个检查周期中发生CKD（估算肾小球滤过率[eGFR]≤60 ml/（min·1.73 m²））的患者，按照年龄和性别1:2与基线时（第5次检查）无CKD的患者进行匹配。在每个检查周期测量CKD风险因素。构建经年龄、性别和时间段调整的逻辑回归模型，以比较病例组和对照组在每个时间点的风险因素概况。在随访期间，确定了441例新的CKD病例，并与882名对照匹配（平均年龄69.2岁，女性占52.4%）。最终发生CKD的患者在CKD诊断前30年更有可能患有高血压（比值比[OR]为1.76；95%置信区间[CI]为1.23至2.51）、肥胖（OR为1.71；95%CI为1.14至2.59）和甘油三酯水平较高（OR为1.43；95%CI为1.12至1.83），在CKD诊断前20年更有可能患有高血压（OR为1.38；95%CI为1.07至1.79）、甘油三酯水平较高（OR为1.35；95%CI为1.11至1.64）、高密度脂蛋白胆固醇（HDLc）较低（OR为0.89；95%CI为0.81至0.97）和糖尿病（OR为2.90；95%CI为1.59至5.29）。这些发现表明，CKD风险因素在诊断前≥30年就可识别，并提示在有CKD风险的患者中早期识别风险因素的重要性。
