Kuwabara Masanari, Hisatome Ichiro, Roncal-Jimenez Carlos A, Niwa Koichiro, Andres-Hernando Ana, Jensen Thomas, Bjornstad Petter, Milagres Tamara, Cicerchi Christina, Song Zhilin, Garcia Gabriela, Sánchez-Lozada Laura G, Ohno Minoru, Lanaspa Miguel A, Johnson Richard J
University of Colorado Denver, School of Medicine, Division of Renal Diseases and Hypertension, Aurora, Colorado, United States of America.
Toranomon Hospital, Department of Cardiology, Tokyo, Japan.
PLoS One. 2017 Jan 12;12(1):e0169137. doi: 10.1371/journal.pone.0169137. eCollection 2017.
Epidemics of chronic kidney disease (CKD) not due to diabetes mellitus (DM) or hypertension have been observed among individuals working in hot environments in several areas of the world. Experimental models have documented that recurrent heat stress and water restriction can lead to CKD, and the mechanism may be mediated by hyperosmolarity that activates pathways (vasopressin, aldose reductase-fructokinase) that induce renal injury. Here we tested the hypothesis that elevated serum sodium, which reflects serum osmolality, may be an independent risk factor for the development of CKD.
This study was a large-scale, single-center, retrospective 5-year cohort study at Center for Preventive Medicine, St. Luke's International Hospital, Tokyo, Japan, between 2004 and 2009. We analyzed 13,201 subjects who underwent annual medical examination of which 12,041 subjects (age 35 to 85) without DM and/or CKD were enrolled. This analysis evaluated age, sex, body mass index, abdominal circumference, hypertension, dyslipidemia, hyperuricemia, fasting glucose, BUN, serum sodium, potassium, chloride and calculated serum osmolarity.
Elevated serum sodium was an independent risk factor for development of CKD (OR: 1.03, 95% CI, 1.00-1.07) after adjusted regression analysis with an 18 percent increased risk for every 5 mmol/L change in serum sodium. Calculated serum osmolarity was also an independent risk factor for CKD (OR: 1.04; 95% CI, 1.03-1.05) as was BUN (OR: 1.08; 95% CI, 1.06-1.10) (independent of serum creatinine).
Elevated serum sodium and calculated serum osmolarity are independent risk factors for developing CKD. This finding supports the role of limiting salt intake and preventing dehydration to reduce risk of CKD.
在世界多个地区，从事高温环境工作的人群中观察到了非糖尿病（DM）或高血压所致的慢性肾脏病（CKD）流行情况。实验模型已证明，反复热应激和限水可导致CKD，其机制可能由高渗介导，高渗激活诱导肾损伤的途径（血管加压素、醛糖还原酶-果糖激酶）。在此，我们检验了这样一个假设，即反映血清渗透压的血清钠升高可能是CKD发生的独立危险因素。
本研究是一项在日本东京圣路加国际医院预防医学中心开展的大规模、单中心、回顾性5年队列研究，时间跨度为2004年至2009年。我们分析了13201名接受年度体检的受试者，其中12041名（年龄35至85岁）无DM和/或CKD的受试者被纳入研究。该分析评估了年龄、性别、体重指数、腹围、高血压、血脂异常、高尿酸血症、空腹血糖、血尿素氮、血清钠、钾、氯，并计算血清渗透压。
经校正回归分析后，血清钠升高是CKD发生的独立危险因素（比值比：1.03，95%置信区间，1.00 - 1.07），血清钠每变化5 mmol/L，风险增加18%。计算所得的血清渗透压也是CKD的独立危险因素（比值比：1.04；95%置信区间，1.03 - 1.05），血尿素氮也是如此（比值比：1.08；95%置信区间，1.06 - 1.10）（独立于血清肌酐）。
血清钠升高和计算所得的血清渗透压是CKD发生的独立危险因素。这一发现支持限制盐摄入和预防脱水以降低CKD风险的作用。
