Mehta Tapan, Buzkova Petra, Kizer Jorge R, Djousse Luc, Chonchol Michel, Mukamal Kenneth J, Shlipak Michael, Ix Joachim H, Jalal Diana
University of Colorado Anschutz Medical Center, Aurora, USA.
University of Washington, Seattle, USA.
BMC Nephrol. 2017 Mar 21;18(1):98. doi: 10.1186/s12882-017-0509-6.
TGF-β is induced in the vasculature with aging suggesting that high plasma TGF-β levels may be a risk factor for chronic kidney disease (CKD) in older adults.
We conducted a cross-sectional analysis of the association between plasma TGF-β levels and CKD including data for 1722 older adults who had participated in the 1996/97 visit of the Cardiovascular Health Study (CHS). Prevalent CKD was defined as eGFR < 60 mL/min/1.73 m or urinary albumin/creatinine ratio (ACR) ≥30 mg/g. We also evaluated whether baseline TGF-β levels predicted change in eGFR, cardiovascular (CV) events, or mortality in longitudinal analysis.
Plasma TGF-β levels were significantly and independently associated with lower eGFR in cross-sectional analysis. Doubling of TGF-β was significantly associated with lower eGFR (β estimate after adjusting for CV risk factors = -1.18, 95% CI -2.03, -0.32). We observed no association with albuminuria. There was no association between baseline TGF-β and change in eGFR, but each doubling of TGF-β at baseline was associated with increased risk of a composite outcome of CV events and mortality, adjusted HR 1.10 (95% C.I. 1.02- 1.20, p = 0.006).
In this large cohort of community-dwelling older individuals, high plasma TGF-β levels are modestly, but independently associated with lower eGFR but not with albuminuria in cross-sectional analysis. In addition, TGF-β levels are associated with increased risk of CV events and mortality. Further research is needed to determine the direction of association between plasma TGF-β and the risk of CKD and CKD-associated morbidities in older adults.
随着年龄增长，血管中会诱导产生转化生长因子-β（TGF-β），这表明血浆中高TGF-β水平可能是老年人慢性肾脏病（CKD）的一个危险因素。
我们对血浆TGF-β水平与CKD之间的关联进行了横断面分析，数据来自1722名参与心血管健康研究（CHS）1996/97年访视的老年人。将现患CKD定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73 m² 或尿白蛋白/肌酐比值（ACR）≥30 mg/g。我们还在纵向分析中评估了基线TGF-β水平是否能预测eGFR的变化、心血管（CV）事件或死亡率。
在横断面分析中，血浆TGF-β水平与较低的eGFR显著且独立相关。TGF-β水平翻倍与较低的eGFR显著相关（校正心血管危险因素后的β估计值=-1.18，95%可信区间-2.03，-0.32）。我们未观察到与蛋白尿有关联。基线TGF-β与eGFR的变化之间无关联，但基线时TGF-β每翻倍一次，与心血管事件和死亡率复合结局的风险增加相关，校正后的风险比为1.10（95%置信区间1.02 - 1.20，p = 0.006）。
在这个大型社区居住老年人群队列中，横断面分析显示，血浆高TGF-β水平与较低的eGFR呈适度但独立的关联，与蛋白尿无关。此外，TGF-β水平与心血管事件和死亡率风险增加相关。需要进一步研究以确定老年人血浆TGF-β与CKD风险及CKD相关并发症之间关联的方向。
