中国肾功能减退、蛋白尿与全因及心血管疾病死亡风险：一项基于人群的队列研究

Reduced Kidney Function, Albuminuria, and Risks for All-cause and Cardiovascular Mortality in China: A Population-based Cohort Study.

作者信息

Wang Jinwei, Wang Fang, Liu Shiwei, Zhou Maigeng, Zhang Luxia, Zhao Minghui

机构信息

Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, China.

Institute of Nephrology, Peking University, Beijing, China.

出版信息

BMC Nephrol. 2017 Jun 7;18(1):188. doi: 10.1186/s12882-017-0603-9.

DOI:10.1186/s12882-017-0603-9

PMID:28592243

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5463353/

Abstract

BACKGROUND

Previous studies have indicated that reduced kidney function and albuminuria are associated with increased risk of mortality and adverse cardiovascular outcomes, however, the evidence from the Asian population is limited. We investigated the association between the indicators of chronic kidney disease (CKD) and all-cause mortality, as well as cardiovascular mortality among a general population in China.

METHODS

We conducted an observational study among 47,204 Chinese adults, from a cross-sectional survey, whose survival status is identified through December 31, 2013. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used as indicators of CKD. We determined the rates of all-cause and cardiovascular mortality.

RESULTS

The incidence rates for both all-cause and cardiovascular mortality increased with the advanced stages of reduced eGFR or elevated ACR. Elevated ACR levels were found to be significantly associated with increased risk of both all-cause and cardiovascular mortality, as shown in the Cox proportional hazards regression model. The multivariable adjusted hazard ratios (HR) associated with all-cause mortality were 1.26 (95% confidence interval [CI]: 1.04-1.53) for those with ACR 30-299 mg/g and 2.07 (95% CI: 1.40-3.04) with ACR ≥ 300 mg/g, compared to those with ACR <30 mg/g. The corresponding HRs for the above ACR levels associated with cardiovascular mortality were 1.08 (95% CI: 0.77-1.50) and 2.32 (95% CI: 1.31-4.12), respectively. We did not identify reduced eGFR as a risk predictor in the multivariable adjusted model for the adverse outcomes in the population, however, an interaction between eGFR and age were detected. Stratified analyses revealed that the associations of reduced eGFR (<60 mL/min/1.73 m) with all-cause mortality were prominent among participants aged less than 65 years.

CONCLUSIONS

Albuminuria was associated with an elevated risk of all-cause and cardiovascular mortality among the Chinese population, however, the association of reduced kidney function with all-cause mortality was not clear.

摘要

背景

既往研究表明，肾功能减退和蛋白尿与死亡风险增加及不良心血管结局相关，但来自亚洲人群的证据有限。我们调查了中国普通人群中慢性肾脏病（CKD）指标与全因死亡率以及心血管死亡率之间的关联。

方法

我们对47204名中国成年人进行了一项观察性研究，数据来自一项横断面调查，通过截至2013年12月31日的生存状态来确定。估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）被用作CKD的指标。我们确定了全因死亡率和心血管死亡率。

结果

全因死亡率和心血管死亡率的发生率均随着eGFR降低或ACR升高的进展阶段而增加。如Cox比例风险回归模型所示，ACR水平升高与全因死亡率和心血管死亡率风险增加显著相关。与ACR<30mg/g者相比，ACR为30 - 299mg/g者全因死亡率的多变量调整风险比（HR）为1.26（95%置信区间[CI]：1.04 - 1.53），ACR≥300mg/g者为2.07（95%CI：1.40 - 3.04）。上述ACR水平与心血管死亡率对应的HR分别为1.08（95%CI：0.77 - 1.50）和2.32（95%CI：1.31 - 4.12）。在多变量调整模型中，我们未将eGFR降低确定为该人群不良结局的风险预测因素，然而，检测到eGFR与年龄之间存在交互作用。分层分析显示，eGFR降低（<60mL/min/1.73m²）与全因死亡率的关联在年龄小于65岁的参与者中较为突出。