Xiong Zibo, Xu Hong, Huang Xiaoyan, Ärnlöv Johan, Qureshi Abdul Rashid, Cederholm Tommy, Sjögren Per, Lindholm Bengt, Risérus Ulf, Carrero Juan Jesús
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China;
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and.
Clin J Am Soc Nephrol. 2015 Apr 7;10(4):584-91. doi: 10.2215/CJN.08830914. Epub 2015 Jan 30.
Although nonesterified fatty acids (NEFAs) are essential as energy substrate for the myocardium, an excess of circulating NEFAs can be harmful. This study aimed to assess plausible relationships between serum NEFA and mortality due to cardiovascular disease (CVD) in individuals with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a prospective cohort study from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of 1221 elderly men aged 70-71 years residing in Uppsala, Sweden. Data collection took place during 1991-1995. All participants had measures of kidney function; this study investigated 623 (51.7%) of these patients with manifest CKD (defined as either eGFR<60 ml/min per 1.73 m(2) or urine albumin excretion rate ≥20 µg/min). Follow-up for mortality was done from examination date until death or December 31, 2007. After a median follow-up of 14 years (interquartile range, 8-16.8), associations of NEFAs with mortality (related to all causes, CVD, ischemic heart disease [IHD], or acute myocardial infarction) were ascertained.
The median serum NEFA was 14.1 mg/dl (interquartile range, 11.3-17.8). No association was found with measures of kidney function. Diabetes and serum triglycerides were the only multivariate correlates of NEFA. During follow-up, 453 participants died, of which 209 deaths were due to CVD, including 88 IHD deaths, with 41 attributed to acute myocardial infarction (AMI). In fully adjusted covariates, serum NEFA was an independent risk factor for all-cause mortality (hazard ratio [HR] per log2 increase, 1.22; 95% confidence interval [95% CI], 1.00 to 1.48) and CVD-related death (HR, 1.51; 95% CI, 1.15 to 1.99), including both IHD (HR, 1.51; 95% CI, 1.00 to 2.32) and AMI mortality (HR, 2.08; 95% CI, 1.09 to 3.98).
Elevated serum NEFA associated with CVD mortality, and particularly with mortality due to AMI, in a homogeneous population of older men with moderate CKD.
尽管非酯化脂肪酸（NEFAs）作为心肌的能量底物至关重要，但循环中NEFAs过量可能有害。本研究旨在评估慢性肾脏病（CKD）患者血清NEFA与心血管疾病（CVD）所致死亡率之间可能存在的关系。
设计、地点、参与者及测量方法：这是一项基于瑞典乌普萨拉70 - 71岁1221名老年男性的乌普萨拉成人男性纵向研究第三个检查周期的前瞻性队列研究。数据收集于1991 - 1995年进行。所有参与者均有肾功能测量值；本研究调查了其中623名（51.7%）患有明显CKD的患者（定义为估算肾小球滤过率[eGFR]<60 ml/min/1.73 m²或尿白蛋白排泄率≥20 μg/min）。对死亡率的随访从检查日期开始直至死亡或2007年12月31日。在中位随访14年（四分位间距，8 - 16.8年）后，确定了NEFAs与死亡率（所有原因、CVD、缺血性心脏病[IHD]或急性心肌梗死相关）之间的关联。
血清NEFA中位数为14.1 mg/dl（四分位间距，11.3 - 17.8）。未发现与肾功能测量值有关联。糖尿病和血清甘油三酯是NEFA仅有的多变量相关因素。随访期间，453名参与者死亡，其中209例死于CVD，包括88例IHD死亡，41例归因于急性心肌梗死（AMI）。在完全调整协变量后，血清NEFA是全因死亡率（每log2增加的风险比[HR]，1.22；95%置信区间[95%CI]，1.00至1.48）和CVD相关死亡（HR，1.51；95%CI，1.15至1.99）的独立危险因素，包括IHD（HR，1.51；95%CI，1.00至2.32）和AMI死亡率（HR，2.08；95%CI，1.09至3.98）。
在患有中度CKD的老年男性同质人群中，血清NEFA升高与CVD死亡率相关，尤其是与AMI所致死亡率相关。
