Kimura Yoshiki, Yamamoto Ryohei, Shinzawa Maki, Isaka Yoshitaka, Iseki Kunitoshi, Yamagata Kunihiro, Tsuruya Kazuhiko, Yoshida Hideaki, Fujimoto Shouichi, Asahi Koichi, Moriyama Toshiki, Watanabe Tsuyoshi
Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.
Health Care Division, Health and Counseling Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan.
Clin Exp Nephrol. 2018 Oct;22(5):1133-1142. doi: 10.1007/s10157-018-1568-0. Epub 2018 Mar 29.
Previous studies report conflicting results of a dose-dependent association between alcohol consumption and incidence of chronic kidney disease. Only a few studies have assessed the clinical impact of > 45-65 g/day of critically high alcohol consumption.
This retrospective cohort study included 88,647 males and 88,925 females with dipstick urinary protein ≤ ± and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m at their first annual health examinations between April 2008 and March 2010 in Japan. The exposure was the self-reported alcohol consumption. The outcome was proteinuria defined as dipstick urinary protein ≥ 1 + or ≥ 2 +.
During median 1.8 years (interquartile range 1.0-2.1) of the observational period, 5416 (6.1%) males and 3262 (3.7%) females developed proteinuria defined as dipstick urinary protein ≥ 1 +. In males, a U-shape association between alcohol consumption and proteinuria was observed in a multivariable-adjusted Poisson regression model [incidence rate ratio (95% confidence interval) of rare, occasional, and daily drinkers with ≤ 19, 20-39, 40-59, and ≥ 60 g/day: 1.00 (reference), 0.86 (0.79-0.94), 0.70 (0.64-0.78), 0.82 (0.75-0.90), 1.00 (0.90-1.11), and 1.00 (0.85-1.17), respectively], whereas a J-shape association was observed in females [1.00 (reference), 0.81 (0.75-0.87), 0.74 (0.64-0.85), 0.93 (0.78-1.11), 1.09 (0.83-1.44), and 1.45 (1.02-2.08), respectively]. Similar associations with dipstick urinary protein ≥ 2 + were shown in males and females.
Moderate alcohol consumption was associated with lower risk of proteinuria in both males and females. Females with ≥ 60 g/day of high alcohol consumption were at higher risk of proteinuria, whereas males were not. Females were more vulnerable to high alcohol consumption, than males.
既往研究报告了饮酒量与慢性肾脏病发病率之间剂量依赖性关联的相互矛盾的结果。仅有少数研究评估了每日饮酒量>45 - 65克这种临界高饮酒量的临床影响。
这项回顾性队列研究纳入了2008年4月至2010年3月在日本首次年度健康检查时尿试纸条检测尿蛋白≤±且估算肾小球滤过率≥60毫升/分钟/1.73平方米的88,647名男性和88,925名女性。暴露因素为自我报告的饮酒量。结局指标为蛋白尿，定义为尿试纸条检测尿蛋白≥1+或≥2+。
在中位1.8年（四分位间距1.0 - 2.1年）的观察期内，5416名（6.1%）男性和3262名（3.7%）女性出现了定义为尿试纸条检测尿蛋白≥1+的蛋白尿。在男性中，多变量调整的泊松回归模型显示饮酒量与蛋白尿之间呈U形关联[每日饮酒量≤19克、20 - 39克、40 - 59克和≥60克的偶尔饮酒者、每日饮酒者的发病率比（95%置信区间）分别为：1.00（参照）、0.86（0.79 - 0.94）、0.70（0.64 - 0.78）、0.82（0.75 - 0.90）、1.00（0.90 - 1.11）和1.00（0.85 - 1.17）]，而在女性中观察到J形关联[分别为1.00（参照）、0.81（0.75 - 0.87）、0.74（0.64 - 0.85）、0.93（0.78 - 1.11）、1.09（0.83 - 1.44）和1.45（1.02 - 2.08）]。男性和女性中尿试纸条检测尿蛋白≥2+时也显示出类似的关联。
适度饮酒与男性和女性蛋白尿风险较低相关。每日饮酒量≥60克的女性蛋白尿风险较高，而男性则不然。女性比男性更容易受到高饮酒量的影响。
