Naik Rakhi P, Derebail Vimal K, Grams Morgan E, Franceschini Nora, Auer Paul L, Peloso Gina M, Young Bessie A, Lettre Guillaume, Peralta Carmen A, Katz Ronit, Hyacinth Hyacinth I, Quarells Rakale C, Grove Megan L, Bick Alexander G, Fontanillas Pierre, Rich Stephen S, Smith Joshua D, Boerwinkle Eric, Rosamond Wayne D, Ito Kaoru, Lanzkron Sophie, Coresh Josef, Correa Adolfo, Sarto Gloria E, Key Nigel S, Jacobs David R, Kathiresan Sekar, Bibbins-Domingo Kirsten, Kshirsagar Abhijit V, Wilson James G, Reiner Alexander P
Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina at Chapel Hill.
JAMA. 2014 Nov 26;312(20):2115-25. doi: 10.1001/jama.2014.15063.
The association between sickle cell trait (SCT) and chronic kidney disease (CKD) is uncertain.
To describe the relationship between SCT and CKD and albuminuria in self-identified African Americans.
DESIGN, SETTING, AND PARTICIPANTS: Using 5 large, prospective, US population-based studies (the Atherosclerosis Risk in Communities Study [ARIC, 1987-2013; n = 3402], Jackson Heart Study [JHS, 2000-2012; n = 2105], Coronary Artery Risk Development in Young Adults [CARDIA, 1985-2006; n = 848], Multi-Ethnic Study of Atherosclerosis [MESA, 2000-2012; n = 1620], and Women's Health Initiative [WHI, 1993-2012; n = 8000]), we evaluated 15,975 self-identified African Americans (1248 participants with SCT [SCT carriers] and 14,727 participants without SCT [noncarriers]).
Primary outcomes were CKD (defined as an estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m2 at baseline or follow-up), incident CKD, albuminuria (defined as a spot urine albumin:creatinine ratio of >30 mg/g or albumin excretion rate >30 mg/24 hours), and decline in eGFR (defined as a decrease of >3 mL/min/1.73 m2 per year). Effect sizes were calculated separately for each cohort and were subsequently meta-analyzed using a random-effects model.
A total of 2233 individuals (239 of 1247 SCT carriers [19.2%] vs 1994 of 14,722 noncarriers [13.5%]) had CKD, 1298 (140 of 675 SCT carriers [20.7%] vs 1158 of 8481 noncarriers [13.7%]) experienced incident CKD, 1719 (150 of 665 SCT carriers [22.6%] vs 1569 of 8249 noncarriers [19.0%]) experienced decline in eGFR, and 1322 (154 of 485 SCT carriers [31.8%] vs 1168 of 5947 noncarriers [19.6%]) had albuminuria during the study period. Individuals with SCT had an increased risk of CKD (odds ratio [OR], 1.57 [95% CI, 1.34-1.84]; absolute risk difference [ARD], 7.6% [95% CI, 4.7%-10.8%]), incident CKD (OR, 1.79 [95% CI, 1.45-2.20]; ARD, 8.5% [95% CI, 5.1%-12.3%]), and decline in eGFR (OR, 1.32 [95% CI, 1.07-1.61]; ARD, 6.1% [95% CI, 1.4%-13.0%]) compared with noncarriers. Sickle cell trait was also associated with albuminuria (OR, 1.86 [95% CI, 1.49-2.31]; ARD, 12.6% [95% CI, 7.7%-17.7%]).
Among African Americans in these cohorts, the presence of SCT was associated with an increased risk of CKD, decline in eGFR, and albuminuria, compared with noncarriers. These findings suggest that SCT may be associated with the higher risk of kidney disease in African Americans.
镰状细胞性状（SCT）与慢性肾脏病（CKD）之间的关联尚不确定。
描述自我认定的非裔美国人中SCT与CKD及蛋白尿之间的关系。
设计、地点和参与者：利用5项大型、前瞻性、基于美国人群的研究（社区动脉粥样硬化风险研究[ARIC，1987 - 2013年；n = 3402]、杰克逊心脏研究[JHS，2000 - 2012年；n = 2105]、青年成年人冠状动脉风险发展研究[CARDIA，1985 - 2006年；n = 848]、多民族动脉粥样硬化研究[MESA，2000 - 2012年；n = 1620]以及妇女健康倡议研究[WHI，1993 - 2012年；n = 8000]），我们评估了15975名自我认定的非裔美国人（1248名SCT参与者[SCT携带者]和14727名非SCT参与者[非携带者]）。
主要结局为CKD（定义为基线或随访时估计肾小球滤过率[eGFR]<60 mL/min/1.73 m²）、新发CKD、蛋白尿（定义为随机尿白蛋白：肌酐比值>30 mg/g或白蛋白排泄率>30 mg/24小时）以及eGFR下降（定义为每年下降>3 mL/min/1.73 m²）。分别计算每个队列的效应量，随后使用随机效应模型进行荟萃分析。
共有2233人（1247名SCT携带者中的239人[19.2%] vs 14722名非携带者中的1994人[13.5%]）患有CKD，1298人（675名SCT携带者中的140人[20.7%] vs 8481名非携带者中的1158人[13.7%]）发生新发CKD，1719人（665名SCT携带者中的150人[22.6%] vs 8249名非携带者中的1569人[19.0%]）出现eGFR下降，1322人（485名SCT携带者中的154人[31.8%] vs 5947名非携带者中的1168人[19.6%]）在研究期间出现蛋白尿。与非携带者相比，SCT个体患CKD的风险增加（优势比[OR]，1.57[95%置信区间，1.34 - 1.84]；绝对风险差异[ARD]，7.6%[95%置信区间，4.7% - 10.8%]）、新发CKD的风险增加（OR，1.79[95%置信区间，1.45 - 2.20]；ARD，8.5%[95%置信区间，5.1% - 12.3%]）以及eGFR下降的风险增加（OR，1.32[95%置信区间，1.07 - 1.61]；ARD，6.1%[95%置信区间，1.4% - 13.0%]）。镰状细胞性状也与蛋白尿相关（OR，1.86[95%置信区间，1.49 - 2.31]；ARD，12.6%[95%置信区间，7.7% - 17.7%]）。
在这些队列中的非裔美国人中，与非携带者相比，SCT的存在与CKD风险增加、eGFR下降及蛋白尿相关。这些发现表明SCT可能与非裔美国人患肾脏疾病的较高风险相关。
