Fu Shihui, Liu Chunling, Luo Leiming, Ye Ping
Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China.
BMC Nephrol. 2017 Nov 9;18(1):331. doi: 10.1186/s12882-017-0743-y.
Predictive abilities of cardiovascular biomarkers to renal function decline are more significant in Chinese community-dwelling population without glomerular filtration rate (GFR) below 60 ml/min/1.73m, and long-term prospective study is an optimal choice to explore this problem. Aim of this analysis was to observe this problem during the follow-up of 5 years.
In a large medical check-up program in Beijing, there were 948 participants with renal function evaluated at baseline and follow-up of 5 years. Physical examinations were performed by well-trained physicians. Blood samples were analyzed by qualified technicians in central laboratory.
Median rate of renal function decline was 1.46 (0.42-2.91) mL/min/1.73m/year. Rapid decline of renal function had a prevalence of 23.5% (223 participants). Multivariate linear and Logistic regression analyses confirmed that age, sex, baseline GFR, homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP) had independently predictive abilities to renal function decline rate and rapid decline of renal function (p < 0.05 for all). High-sensitivity cardiac troponin T (hs-cTnT), carotid femoral pulse wave velocity and central augmentation index had no statistically independent association with renal function decline rate and rapid decline of renal function (p > 0.05 for all).
Homocysteine and NT-proBNP rather than hs-cTnT had independently predictive abilities to rapid decline of renal function in Chinese community-dwelling population without GFR below 60 ml/min/1.73m. Baseline GFR was an independent factor predicting the rapid decline of renal function. Arterial stiffness and compliance had no independent effect on rapid decline of renal function. This analysis has a significant implication for public health, and changing the homocysteine and NT-proBNP levels might slow the rapid decline of renal function.
心血管生物标志物对肾功能下降的预测能力在估算肾小球滤过率（eGFR）不低于60ml/min/1.73m²的中国社区居民中更为显著，长期前瞻性研究是探索该问题的最佳选择。本分析的目的是在5年随访期间观察这一问题。
在北京一项大型体检项目中，有948名参与者在基线和5年随访时进行了肾功能评估。体格检查由训练有素的医生进行。血样由中心实验室的合格技术人员进行分析。
肾功能下降的中位数速率为1.46（0.42 - 2.91）ml/min/1.73m²/年。肾功能快速下降的患病率为23.5%（223名参与者）。多变量线性和逻辑回归分析证实，年龄、性别、基线eGFR、同型半胱氨酸和N末端B型利钠肽原（NT-proBNP）对肾功能下降速率和肾功能快速下降具有独立预测能力（所有p < 0.05）。高敏心肌肌钙蛋白T（hs-cTnT）、颈股脉搏波速度和中心动脉增强指数与肾功能下降速率和肾功能快速下降无统计学独立关联（所有p > 0.05）。
在中国eGFR不低于60ml/min/1.73m²的社区居民中，同型半胱氨酸和NT-proBNP而非hs-cTnT对肾功能快速下降具有独立预测能力。基线eGFR是预测肾功能快速下降的独立因素。动脉僵硬度和顺应性对肾功能快速下降无独立影响。本分析对公共卫生具有重要意义，改变同型半胱氨酸和NT-proBNP水平可能减缓肾功能的快速下降。
