中国一个健康体检队列中血清尿酸水平升高与肾功能下降风险增加之间的关联。
The association between elevated serum uric acid level and an increased risk of renal function decline in a health checkup cohort in China.
作者信息
Cao Xia, Wu Liuxin, Chen Zhiheng
机构信息
Department of Health Management, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha, 410013, Hunan Province, China.
Zhongguancun Xinzhiyuan Health Management Institute, Beijing, China, 100011.
出版信息
Int Urol Nephrol. 2018 Mar;50(3):517-525. doi: 10.1007/s11255-017-1732-6. Epub 2017 Nov 1.
PURPOSE
To investigate whether an elevated serum uric acid (SUA) level is an independent risk factor for rapid decline in renal function or new-onset chronic kidney disease (CKD) in a Chinese health checkup population.
METHODS
A cohort study of 6495 Chinese individuals who underwent health checkups with normal estimated glomerular filtration rate (eGFR) at baseline was carried out from May 2011 to April 2016. Examinations included a questionnaire, physical measurements, and blood sampling. The gender-specific quartiles of blood uric acid were used to present baseline descriptive data. Rapid decline of renal function was defined as eGFR loss of > 3 mL/min/1.73 m/year. New-onset CKD was defined as follow-up eGFR < 60 mL/min/1.73 m or positive proteinuria. Multivariable logistic regression was used to assess the relationship between serum uric acid and the following outcomes: rapid decline of renal function, incident CKD, and combined renal outcomes.
RESULTS
During mean follow-up of 52.8 months, 1608 (24.8%) individuals reached combined renal events. Rapid decline in renal function developed in 1506 (23.2%) individuals, and incident CKD was documented in 372 (5.7%) individuals. In a multivariate model adjusted for age, BMI, diabetes, hypertension, alcohol drinking, SBP, total cholesterol, and eGFR, the odds ratio for rapid decline of renal function increased across quartiles of serum uric acid level, reaching a 1.32 (95% CI 1.02-2.97) for the top quartile compared to the lowest quartile (P for trend < 0.001). Meanwhile, higher SUA was also associated with incident CKD in all models. Furthermore, an increased risk of reaching renal outcomes across increasing quartiles of SUA levels appeared to be similar among subgroups stratified according to age, eGFR, and SBP (P < 0.05 in all).
CONCLUSIONS
These findings suggest that higher SUA may predict progressive renal damage and dysfunction in a health checkup population in China.
目的
探讨血清尿酸（SUA）水平升高是否是中国健康体检人群肾功能快速下降或新发慢性肾脏病（CKD）的独立危险因素。
方法
对2011年5月至2016年4月期间6495名基线估计肾小球滤过率（eGFR）正常的接受健康体检的中国人进行队列研究。检查包括问卷调查、体格测量和血液采样。采用按性别划分的血尿酸四分位数来呈现基线描述性数据。肾功能快速下降定义为eGFR下降>3 mL/min/1.73 m²/年。新发CKD定义为随访时eGFR<60 mL/min/1.73 m²或蛋白尿阳性。采用多变量逻辑回归评估血清尿酸与以下结局之间的关系：肾功能快速下降、CKD发病及综合肾脏结局。
结果
在平均52.8个月的随访期间，1608名（24.8%）个体发生了综合肾脏事件。1506名（23.2%）个体出现肾功能快速下降，372名（5.7%）个体记录到新发CKD。在调整了年龄、体重指数、糖尿病、高血压、饮酒、收缩压、总胆固醇和eGFR的多变量模型中，肾功能快速下降的比值比随血清尿酸水平四分位数的增加而升高，与最低四分位数相比，最高四分位数的比值比达到1.32（95%CI 1.02 - 2.97）（趋势P<0.001）。同时，在所有模型中，较高的SUA也与CKD发病相关。此外，在根据年龄、eGFR和收缩压分层的亚组中，随着SUA水平四分位数的增加，达到肾脏结局的风险增加似乎相似（所有P<0.05）。
结论
这些发现表明，较高的SUA可能预示着中国健康体检人群中进行性肾损伤和功能障碍。
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