Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.
Department of Medicine 1, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany.
Nephrol Dial Transplant. 2018 Feb 1;33(2):257-264. doi: 10.1093/ndt/gfw396.
Estimated albumin excretion rate (eAER) provides a better estimate of 24-h albuminuria than albumin:creatinine ratio (ACR). However, whether eAER is superior to ACR in predicting end-stage renal disease (ESRD), vascular events (VEs) or death is uncertain.
The prognostic utility of ACR and eAER (estimated from ACR, sex, age and race) to predict mortality, ESRD and VEs was compared using Cox proportional hazards regression among 5552 participants with chronic kidney disease in the Study of Heart and Renal Protection, who were not on dialysis at baseline.
During a median follow-up of 4.8 years, 1959 participants developed ESRD, 1204 had a VE and 1130 died (641 from a non-vascular, 369 from a vascular and 120 from an unknown cause). After adjustment for age, sex and eGFR, both ACR and eAER were strongly and similarly associated with ESRD risk. The average relative risk (RR) per 10-fold higher level was 2.70 (95% confidence interval 2.45-2.98) for ACR and 2.67 (2.43-2.94) for eAER. Neither ACR nor eAER provided any additional prognostic information for ESRD risk over and above the other. For VEs, there were modest positive associations between both ACR and eAER and risk [adjusted RR per 10-fold higher level 1.37 (1.22-1.53) for ACR and 1.36 (1.22-1.52) for eAER]. Again, neither measure added prognostic information over and above the other. Similar results were observed when ACR and eAER were related to vascular mortality [RR per 10-fold higher level: 1.64 (1.33-2.03) and 1.62 (1.32-2.00), respectively] or to non-vascular mortality [1.53 (1.31-1.79) and 1.50 (1.29-1.76), respectively].
In this study, eAER did not improve risk prediction of ESRD, VEs or mortality.
与白蛋白/肌酐比值（ACR）相比，估计的白蛋白排泄率（eAER）能更好地估计 24 小时尿白蛋白。然而，eAER 是否优于 ACR 来预测终末期肾病（ESRD）、血管事件（VE）或死亡尚不确定。
在基线时未接受透析的 5552 例慢性肾脏病患者中，使用 Cox 比例风险回归比较了 ACR 和 eAER（根据 ACR、性别、年龄和种族估计）对死亡率、ESRD 和 VE 的预测价值。
在中位随访 4.8 年期间，1959 例患者发生 ESRD，1204 例发生 VE，1130 例患者死亡（641 例非血管性死亡，369 例血管性死亡，120 例死因不明）。在调整年龄、性别和 eGFR 后，ACR 和 eAER 与 ESRD 风险均呈强烈且相似的相关性。ACR 和 eAER 每增加 10 倍，ESRD 风险的平均相对风险（RR）分别为 2.70（95%置信区间 2.45-2.98）和 2.67（2.43-2.94）。ACR 和 eAER 均未提供任何比其他因素更多的 ESRD 风险预测信息。对于 VE，ACR 和 eAER 与风险之间存在适度的正相关关系[ACR 每增加 10 倍，调整后的 RR 为 1.37（1.22-1.53），eAER 为 1.36（1.22-1.52）]。同样，两者都没有提供比其他因素更多的预后信息。当 ACR 和 eAER 与血管死亡率[RR 每增加 10 倍：1.64（1.33-2.03）和 1.62（1.32-2.00）]或非血管死亡率[1.53（1.31-1.79）和 1.50（1.29-1.76）]相关时，也观察到类似的结果。
在这项研究中，eAER 并未改善 ESRD、VE 或死亡率的风险预测。
