Center for Preventive Medicine, Keio University Hospital.
Department of Internal Medicine, School of Medicine, Keio University.
J Atheroscler Thromb. 2017 Aug 1;24(8):863-875. doi: 10.5551/jat.38612. Epub 2017 Jan 26.
Early intervention before the progression of chronic kidney disease (CKD) is essential to prevent end-stage renal disease (ESRD) and cardiovascular complications. This study evaluated the correlation between metabolic and lifestyle-related factors and the decline of estimated glomerular filtration rate (eGFR) over 1 year in a Japanese population without CKD.
Subjects who received two consecutive annual health checkups from 2013 to 2015 were involved. Factors associated with eGFR decline were identified using multiple regression models.
A total of 2531 subjects aged 58.9±11.7 years old were included in this study. Baseline levels of HDL-C and ApoA1 correlated with the eGFR decline over 1 year defined as eGFR reduction rate of 15% or more and/or eGFR at the next year ＜60 ml/min/m (odds ratio (OR) 0.87 (per 10 mg/dl); 95% CI, 0.80-0.94; p=0.0012, 0.90 (per 10 mg/dl); 0.86-0.96; p=0.0004, respectively). A U-shaped relationship between the eGFR decline and HDL-C or ApoA1 levels was not observed in non-CKD population of this study. Metabolic syndrome was significantly associated with eGFR decline (OR 1.32; 1.04-1.67; p=0.0205), although obesity-related factors did not show a significant correlation with eGFR decline over 1 year.
Low HDL-C and ApoA1 levels significantly correlated with eGFR decline in a short period of 1 year. Metabolic syndrome also showed a significant association with eGFR decline. This study suggests the importance of hypertension and low HDL-C in the metabolic syndrome effect on eGFR decline rather than obesity in non-CKD population.
在慢性肾脏病（CKD）进展之前进行早期干预对于预防终末期肾脏疾病（ESRD）和心血管并发症至关重要。本研究评估了代谢和生活方式相关因素与日本无 CKD 人群中肾小球滤过率（eGFR）在 1 年内下降之间的相关性。
本研究纳入了 2013 年至 2015 年连续两次接受年度健康检查的受试者。使用多元回归模型确定与 eGFR 下降相关的因素。
本研究共纳入 2531 名年龄为 58.9±11.7 岁的受试者。基线高密度脂蛋白胆固醇（HDL-C）和载脂蛋白 A1（ApoA1）水平与 1 年内 eGFR 下降相关，定义为 eGFR 下降率≥15%和/或下一年 eGFR＜60ml/min/m（比值比（OR）0.87（每 10mg/dl）；95%置信区间，0.80-0.94；p=0.0012，0.90（每 10mg/dl）；0.86-0.96；p=0.0004）。在本研究的非 CKD 人群中，未观察到 eGFR 下降与 HDL-C 或 ApoA1 水平之间的 U 型关系。代谢综合征与 eGFR 下降显著相关（OR 1.32；1.04-1.67；p=0.0205），尽管肥胖相关因素与 1 年内 eGFR 下降无显著相关性。
低水平的 HDL-C 和 ApoA1 与 eGFR 在 1 年内的下降显著相关。代谢综合征也与 eGFR 下降显著相关。本研究表明，在非 CKD 人群中，高血压和低 HDL-C 在代谢综合征对 eGFR 下降的影响中比肥胖更为重要。
