血清白蛋白水平与老年人肾功能下降和慢性肾脏病发病的关系。
Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders.
机构信息
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Kidney Research Institute, University of Washington, Seattle, WA, USA.
出版信息
Nephrol Dial Transplant. 2018 Jun 1;33(6):986-992. doi: 10.1093/ndt/gfx229.
BACKGROUND
Previous studies in HIV-infected individuals have demonstrated serum albumin to be strongly associated with kidney function decline, independent of urine albumin and inflammatory markers. Lower serum albumin concentrations may be an under-appreciated risk factor for kidney function decline in elders.
METHODS
We performed a cohort analysis in the Health Aging and Body Composition Study, a cohort of well-functioning, bi-racial, community-dwelling elders between the age of 70 and 79 years. We examined the associations of serum albumin concentration with longitudinal kidney function decline by estimated glomerular filtration rate (eGFR). Outcomes included linear eGFR decline, rapid kidney function decline defined as >30% decrease in eGFR, defined as a final eGFR <60 mL/min/1.73 m2 in those with an eGFR >60 mL/min/1.73 m2 at baseline. Cystatin C-based eGFR was calculated at baseline, Year 3 and Year 10.
RESULTS
Mean age was 74 years, and mean eGFR was 73 mL/min/1.73 m2 at baseline. The mean rate of eGFR change was 1.81 mL/min/1.73 m2 per year. After multivariate adjustment, lower serum albumin concentrations were strongly and independently associated with kidney function decline (-0.11 mL/min/1.73 m2 per year for each standard deviation decrease serum albumin; -0.01 to - 0.20) with no attenuation after adjustment for urine albumin and inflammatory markers (-0.12, -0.03 to - 0.22). When divided into quartiles, serum albumin levels ≤3.80 g/dL were associated with increased odds of rapid kidney function decline (odds ratio 1.59; 1.12-2.26) and increased risk of incident chronic kidney disease (incident rate ratio 1.29; 1.03-1.62) relative to levels >4.21g/dL. Urine albumin to creatinine ratio (ACR) was also significantly and independently associated with kidney function decline (-0.08 mL/min/1.73 m2 per year for urine ACR >30 mg/g; -0.82 to - 0.13).
CONCLUSIONS
Lower serum albumin levels are strongly and independently associated with kidney function decline in elders, independent of clinical risk factors, urine albumin and measured inflammatory markers.
背景
先前在 HIV 感染者中的研究表明，血清白蛋白与肾功能下降密切相关，而与尿白蛋白和炎症标志物无关。血清白蛋白浓度较低可能是老年人肾功能下降的一个被低估的危险因素。
方法
我们在健康老龄化和身体成分研究（Health Aging and Body Composition Study）中进行了队列分析，该研究是一个由 70 至 79 岁之间的、功能良好的、双种族、社区居住的老年人组成的队列。我们通过估计肾小球滤过率（estimated glomerular filtration rate，eGFR）来检查血清白蛋白浓度与纵向肾功能下降的关系。结果包括线性 eGFR 下降，快速肾功能下降定义为 eGFR 下降超过 30%，在基线时 eGFR>60 mL/min/1.73 m2 的患者中，最终 eGFR<60 mL/min/1.73 m2。基线、第 3 年和第 10 年计算基于半胱氨酸蛋白酶抑制剂的 eGFR。
结果
平均年龄为 74 岁，基线时平均 eGFR 为 73 mL/min/1.73 m2。eGFR 变化的平均速度为每年 1.81 mL/min/1.73 m2。经过多变量调整后，较低的血清白蛋白浓度与肾功能下降密切相关（每标准偏差降低血清白蛋白，每年 eGFR 下降 0.11 mL/min/1.73 m2；-0.01 至-0.20），调整尿白蛋白和炎症标志物后无减弱（-0.12，-0.03 至-0.22）。当分为四等分时，血清白蛋白水平≤3.80 g/dL 与快速肾功能下降的几率增加相关（比值比 1.59；1.12-2.26），与水平>4.21 g/dL 相比，发生慢性肾脏病的风险增加（发生率比 1.29；1.03-1.62）。尿白蛋白与肌酐比值（urine albumin to creatinine ratio，ACR）也与肾功能下降显著相关（ACR>30mg/g 时，每年 eGFR 下降 0.08 mL/min/1.73 m2；-0.82 至-0.13）。
结论
在老年人中，较低的血清白蛋白水平与肾功能下降密切相关，独立于临床危险因素、尿白蛋白和测量的炎症标志物。
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