估算肾小球滤过率在正常或轻度受损范围内与心血管疾病发病风险。
Estimated Glomerular Filtration Rate Within the Normal or Mildly Impaired Range and Incident Cardiovascular Disease.
机构信息
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clalit Health Research Institute, Tel Aviv, Israel.
出版信息
Am J Med. 2015 Sep;128(9):1015-22.e2. doi: 10.1016/j.amjmed.2015.03.024. Epub 2015 Apr 9.
BACKGROUND
The association between lower estimated glomerular filtration rate (eGFR) and incident cardiovascular disease is less clear within the normal or mildly impaired range.
METHODS
Using the Chronic Kidney Disease EPIdemiology collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) eGFR formulas, we analyzed outpatients ≥ 22 years old from 2004-2006 with 60 mL/min/1.73 m(2) < eGFR < 130 mL/min/1.73 m(2), without prior cardiovascular disease, and with and without proteinuria.
RESULTS
During a median follow-up of 96 months and > 10 million patient-years of follow-up, 103,506 and 104,315 cardiovascular events were recorded using CKD-EPI (n = 1,341,400, mean age 49.2 years, 42.6% male) and MDRD (n = 1,284,762, mean age 50.2 years, 43.4% male) formulas, respectively (incident event rates 4.4% and 4.6%, respectively). Adjusting for age, sex, and major cardiovascular risk factors, a 10-unit eGFR increase was independently associated with a mean decrease of 3.0% and 1.0% in incident cardiovascular events, using CKD-EPI and MDRD, respectively (P < .001 for both), with a sharp decrease in events in the 100-mL/min/1.73 m(2) < eGFR < 130 mL/min/1.73 m(2) range in the CKD-EPI, but not the MDRD, cohort. Using net reclassification analysis, CKD-EPI was more accurate in predicting events than MDRD (Net Reclassification Improvement 0.39, P < .001 stratifying patients to eGFR deciles and 0.64, P < .001 as a continuous variable). Using both formulas, eGFR was predictive of incident cardiovascular disease for patients without proteinuria, but not for the 2.4% with proteinuria (P < .001 for interaction).
CONCLUSION
Higher eGFR is associated with fewer cardiovascular events in adults without prior cardiovascular disease and without proteinuria, particularly in the 100-mL/min/1.73 m(2) < eGFR < 130 mL/min/1.73 m(2) range, indicating that eGFR, especially using the CKD-EPI formula, may be an independent risk marker for incident cardiovascular disease.
背景
肾小球滤过率（eGFR）估计值较低与心血管疾病的发生之间的关联在正常或轻度受损范围内不太明确。
方法
使用慢性肾脏病流行病学合作（CKD-EPI）和改良肾脏病饮食研究（MDRD）eGFR 公式，我们分析了 2004 年至 2006 年间年龄≥22 岁、eGFR 为 60 mL/min/1.73 m²＜eGFR＜130 mL/min/1.73 m²、无既往心血管疾病且无蛋白尿的门诊患者。
结果
在中位随访 96 个月和超过 1000 万患者年的随访期间，使用 CKD-EPI（n=1341400，平均年龄 49.2 岁，42.6%为男性）和 MDRD（n=1284762，平均年龄 50.2 岁，43.4%为男性）公式分别记录了 103506 和 104315 例心血管事件（事件发生率分别为 4.4%和 4.6%）。在校正年龄、性别和主要心血管危险因素后，eGFR 每增加 10 个单位，与 CKD-EPI 和 MDRD 分别发生心血管事件的平均风险降低 3.0%和 1.0%相关（均 P＜0.001），在 CKD-EPI 队列中，eGFR 在 100-mL/min/1.73 m²＜eGFR＜130-mL/min/1.73 m²范围内的事件急剧减少，但在 MDRD 队列中则不然。使用净重新分类分析，与 MDRD 相比，CKD-EPI 更能准确预测事件（重新分类改善 0.39，P＜0.001，按 eGFR 十分位数分层和 0.64，P＜0.001，作为连续变量）。使用两种公式，eGFR 均能预测无蛋白尿患者的心血管事件，但不能预测有蛋白尿的 2.4%患者的心血管事件（交互作用 P＜0.001）。
结论
在无既往心血管疾病和无蛋白尿的成年人中，较高的 eGFR 与较少的心血管事件相关，特别是在 100-mL/min/1.73 m²＜eGFR＜130-mL/min/1.73 m²范围内，表明 eGFR，特别是使用 CKD-EPI 公式，可能是心血管疾病发生的独立风险标志物。
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