Ashitani Aki, Ueno Toshinori, Nakashima Ayumu, Doi Shigehiro, Yamane Kiminori, Masaki Takao
Department of Nephrology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Nippon Telegraph and Telephone West Corp., Chugoku Health Administration Center, 11-40, Hijiyama-honmachi, Minami-ku, Hiroshima, 732-0816, Japan.
Clin Exp Nephrol. 2018 Aug;22(4):835-842. doi: 10.1007/s10157-017-1522-6. Epub 2017 Dec 26.
High-normal albuminuria is an important risk factor for incident chronic kidney disease in diabetic populations, in contrast to an uncertain association in nondiabetic populations. This study aimed to reveal the relationship between high-normal albuminuria and incident chronic kidney disease in a Japanese nondiabetic population.
A 10-year follow-up retrospective cohort study was performed involving 1378 Japanese men (mean age 44 ± 5.3 years) without chronic kidney disease and diabetes mellitus. Chronic kidney disease was diagnosed as either estimated glomerular filtration rate < 60 mL/min/1.73 m or a urine albumin-to-creatinine ratio ≥ 30 mg/g.
At baseline, age, estimated glomerular filtration rate, and the presence of hematuria, hypertension, and dyslipidemia were independently associated with the albumin-to-creatinine ratio. Among the 1378 participants, 185 (13.4%) fulfilled diagnostic criteria for chronic kidney disease over the 10-year follow-up period. Median annual estimated glomerular filtration rate decline showed a deterioration with increasing quartiles of baseline albumin-to-creatinine ratio (P = 0.004). Participants who had a baseline albumin-to-creatinine ratio in the highest quartile (5.9-28.9 mg/g) were more likely to develop micro- or macroalbuminuria (odds ratio: 16.23, 95% confidence interval 6.56-54.03), chronic kidney disease (odds ratio: 2.48, 95% confidence interval 1.64-3.82), and hypertension (odds ratio 2.06, 95% confidence interval 1.30-3.31), but not diabetes mellitus compared with those who had an albumin-to-creatinine ratio in the lowest quartile (1.3-3.6 mg/g) after adjustment for potential confounders.
High-normal albuminuria was associated with incident chronic kidney disease in this Japanese nondiabetic male population.
高正常蛋白尿是糖尿病患者发生慢性肾脏病的重要危险因素，相比之下，在非糖尿病患者人群中其关联尚不明确。本研究旨在揭示日本非糖尿病人群中高正常蛋白尿与慢性肾脏病发病之间的关系。
进行了一项为期10年的随访回顾性队列研究，纳入1378名无慢性肾脏病和糖尿病的日本男性（平均年龄44±5.3岁）。慢性肾脏病的诊断标准为估算肾小球滤过率<60 mL/min/1.73 m²或尿白蛋白肌酐比值≥30 mg/g。
在基线时，年龄、估算肾小球滤过率以及血尿、高血压和血脂异常的存在与白蛋白肌酐比值独立相关。在1378名参与者中，185名（13.4%）在10年随访期内符合慢性肾脏病的诊断标准。校正潜在混杂因素后，年度估算肾小球滤过率下降中位数随基线白蛋白肌酐比值四分位数的增加而恶化（P = 0.004）。与基线白蛋白肌酐比值处于最低四分位数（1.3 - 3.6 mg/g）的参与者相比，处于最高四分位数（5.9 - 28.9 mg/g）的参与者更有可能出现微量或大量蛋白尿（比值比：16.23，95%置信区间6.56 - 54.03）、慢性肾脏病（比值比：2.48，95%置信区间1.64 - 3.82）和高血压（比值比2.06，95%置信区间1.30 - 3.31），但糖尿病的发病风险无差异。
在日本非糖尿病男性人群中，高正常蛋白尿与慢性肾脏病发病相关。
