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尿调节素与肾功能下降及死亡率的关联:健康ABC研究

Association of urinary uromodulin with kidney function decline and mortality: the health ABC study
.

作者信息

Garimella Pranav S, Katz Ronit, Ix Joachim H, Fried Linda F, Kritchevsky Stephen B, Devarajan Prasad, Bennett Michael R, Parikh Chirag R, Shlipak Michael G, Harris Tamara B, Gutiérrez Orlando M, Sarnak Mark J

出版信息

Clin Nephrol. 2017 Jun;87(6):278-286. doi: 10.5414/CN109005.

Abstract

BACKGROUND

Urine uromodulin (uUMOD) is a protein secreted by the kidney tubule. Recent studies have suggested that higher uUMOD may be associated with improved kidney and mortality outcomes.

METHODS

Using a case-cohort design, we evaluated the association between baseline uUMOD levels and ≥ 30% estimated glomerular filtration rate (eGFR) decline, incident chronic kidney disease (CKD), rapid kidney function decline, and mortality using standard and modified Cox proportional hazards regression.

RESULTS

The median value of uUMOD was 25.8 µg/mL, mean age of participants was 74 years, 48% were women, and 39% were black. Persons with higher uUMOD had lower prevalence of diabetes and coronary artery disease (CAD), and had lower systolic blood pressure. Persons with higher uUMOD also had higher eGFR, lower urinary albumin to creatinine ratio (ACR), and lower C-reactive protein (CRP). There was no association of uUMOD with > 30% eGFR decline. In comparison to those in the lowest quartile of uUMOD, those in the highest quartile had a significantly (53%) lower risk of incident CKD (CI 73%, 18%) and a 51% lower risk of rapid kidney function decline (CI 76%, 1%) after multivariable adjustment. Higher uUMOD was associated with lower risk of mortality in demographic adjusted models, but not after multivariable adjustment.

CONCLUSION: Higher levels of uUMOD are associated with lower risk of incident CKD and rapid kidney function decline. Additional studies are needed in the general population and in persons with advanced CKD to confirm these findings.
.

摘要

背景

尿调节素(uUMOD)是一种由肾小管分泌的蛋白质。最近的研究表明,较高的uUMOD水平可能与改善肾脏和死亡率结局相关。

方法

采用病例队列设计,我们使用标准和改良的Cox比例风险回归评估基线uUMOD水平与估计肾小球滤过率(eGFR)下降≥30%、新发慢性肾脏病(CKD)、肾功能快速下降和死亡率之间的关联。

结果

uUMOD的中位数为25.8μg/mL,参与者的平均年龄为74岁,48%为女性,39%为黑人。uUMOD水平较高的人糖尿病和冠状动脉疾病(CAD)的患病率较低,收缩压也较低。uUMOD水平较高的人eGFR也较高,尿白蛋白肌酐比值(ACR)较低,C反应蛋白(CRP)较低。uUMOD与eGFR下降>30%无关联。与uUMOD最低四分位数的人相比,最高四分位数的人在多变量调整后发生CKD的风险显著降低(53%)(CI 73%,18%),肾功能快速下降的风险降低51%(CI 76%,1%)。在人口统计学调整模型中,较高的uUMOD与较低的死亡风险相关,但在多变量调整后则不然。

结论

较高水平的uUMOD与新发CKD和肾功能快速下降的风险较低相关。需要在一般人群和晚期CKD患者中进行更多研究以证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c2db/6102560/20f87e999e55/clinnephrol-87-278-01.jpg

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