多种滤过标志物的变化与随后的心血管疾病风险及死亡率
Change in Multiple Filtration Markers and Subsequent Risk of Cardiovascular Disease and Mortality.
作者信息
Rebholz Casey M, Grams Morgan E, Matsushita Kunihiro, Inker Lesley A, Foster Meredith C, Levey Andrew S, Selvin Elizabeth, Coresh Josef
机构信息
Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Divisions of Nephrology and.
出版信息
Clin J Am Soc Nephrol. 2015 Jun 5;10(6):941-8. doi: 10.2215/CJN.10101014. Epub 2015 Mar 30.
BACKGROUND AND OBJECTIVES
Kidney disease progression, assessed by change in eGFR on the basis of creatinine, is an independent risk factor for cardiovascular disease and death. This study aimed to evaluate whether changes in multiple filtration markers, individually and combined, were associated with cardiovascular disease and death.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Creatinine, cystatin C, and β2-microglobulin were measured among 9716 Atherosclerosis Risk in Communities Study participants in 1990-1992 and 1996-1998. Percentage change in three filtration markers (eGFR on the basis of creatinine, eGFR on the basis of cystatin C, and 1/β2-microglobulin) individually and the average of percentage change across all three filtration markers were calculated. Cardiovascular events and deaths were ascertained from 1996 to 2011. Cox regression models were adjusted for established risk factors for cardiovascular disease and mortality and first measurement of eGFR on the basis of creatinine.
RESULTS
During a median follow-up of 14 years, there were 1922 cardiovascular events and 2285 deaths from any cause. Decline of >30% in each filtration marker was significantly associated with higher risk of mortality compared with stable kidney function (-9.9% to +9.9% change in the filtration marker) with hazard ratios (95% confidence intervals) of 1.91 (1.67 to 2.18) for eGFR on the basis of creatinine, 2.29 (1.99 to 2.63) for eGFR on the basis of cystatin C, and 2.48 (2.15 to 2.86) for 1/β2-microglobulin, with similar associations for cardiovascular disease. An average decline of >30% across the three markers was strongly associated with higher risk of all-cause mortality (hazard ratio, 2.82; 95% confidence interval, 2.42 to 3.29).
CONCLUSIONS
Kidney disease progression was assessed using >30% decline in eGFR on the basis of creatinine, eGFR on the basis of cystatin C, and 1/β2-microglobulin and average decline of >30% across the three filtration markers is strongly associated with risk of cardiovascular disease and death.
背景与目的
基于肌酐的估算肾小球滤过率（eGFR）变化所评估的肾脏疾病进展是心血管疾病和死亡的独立危险因素。本研究旨在评估多种滤过标志物的变化，单独及联合起来，是否与心血管疾病和死亡相关。
设计、地点、参与者及测量方法：在1990 - 1992年和1996 - 1998年期间，对9716名社区动脉粥样硬化风险研究参与者测量了肌酐、胱抑素C和β2-微球蛋白。分别计算了三种滤过标志物（基于肌酐的eGFR、基于胱抑素C的eGFR和1/β2-微球蛋白）的百分比变化以及所有三种滤过标志物百分比变化的平均值。确定了1996年至2011年期间的心血管事件和死亡情况。Cox回归模型针对已确定的心血管疾病和死亡率危险因素以及基于肌酐的eGFR首次测量值进行了调整。
结果
在中位随访14年期间，有1922例心血管事件和2285例任何原因导致的死亡。与肾功能稳定（滤过标志物变化在 - 9.9%至 + 9.9%之间）相比，每种滤过标志物下降>30%与更高的死亡风险显著相关，基于肌酐的eGFR的风险比（95%置信区间）为1.91（1.67至2.18），基于胱抑素C的eGFR为2.29（1.99至2.63），1/β2-微球蛋白为2.48（2.15至2.86），心血管疾病的关联相似。三种标志物平均下降>30%与全因死亡风险显著升高密切相关（风险比，2.82；95%置信区间，2.42至3.29）。
结论
使用基于肌酐的eGFR下降>30%、基于胱抑素C的eGFR下降>30%以及1/β2-微球蛋白下降>30%来评估肾脏疾病进展，且三种滤过标志物平均下降>30%与心血管疾病和死亡风险密切相关。
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