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慢性肾脏病患者左心室肥厚增加的危险因素:CKD-JAC研究结果

Risk factors for increased left ventricular hypertrophy in patients with chronic kidney disease: findings from the CKD-JAC study.

作者信息

Nitta Kosaku, Iimuro Satoshi, Imai Enyu, Matsuo Seiichi, Makino Hirofumi, Akizawa Tadao, Watanabe Tsuyoshi, Ohashi Yasuo, Hishida Akira

机构信息

Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, 162-8666, Japan.

Teikyo Academic Research Center, Teikyo University, Tokyo, Japan.

出版信息

Clin Exp Nephrol. 2019 Jan;23(1):85-98. doi: 10.1007/s10157-018-1605-z. Epub 2018 Jun 27.

Abstract

BACKGROUND

Although left ventricular hypertrophy (LVH) has been established as a predictor of cardiovascular events in chronic kidney disease (CKD), the relationship between the prevalence of LVH and CKD stage during the pre-dialysis period has not been fully examined.

METHODS

We measured left ventricular mass index (LVMI) in a cross-sectional cohort of participants in the Chronic Kidney Disease Japan Cohort (CKD-JAC) study to identify factors that are associated with increased LVMI in patients with stage 3-5 CKD.

RESULTS

We analyzed the baseline characteristics in 1088 participants (male 63.8%, female 36.2%). Diabetes mellitus was the underlying disease in 41.7% of the patients, and mean age was 61.8 ± 11.1 years. LVH was detected in 23.4% of the patients at baseline. By multivariate logistic analysis, independent risk factors for LVH were past history of cardiovascular disease [odds ratio (OR) 2.364; 95% confidence interval ([CI) 1.463-3.822; P = 0.0004], body mass index (OR 1.108; 95% CI 1.046-1.173; P = 0.0005), systolic blood pressure (OR 1.173; 95% CI 1.005-1.369; P = 0.0433), urinary albumin (OR 1.425; 95% CI 1.028-1.974; P = 0.0333), and serum total cholesterol level (OR 0.994; 95% CI 0.989-0.999; P = 0.0174).

CONCLUSION

The cross-sectional baseline data from the CKD-JAC study shed light on the association between LVH and risk factors in patients with decreased renal function. Further longitudinal analyses of the CKD-JAC cohort are needed to evaluate the prognostic value of LVH in CKD patients.

摘要

背景

尽管左心室肥厚(LVH)已被确认为慢性肾脏病(CKD)中心血管事件的预测指标,但透析前期LVH患病率与CKD分期之间的关系尚未得到充分研究。

方法

我们在日本慢性肾脏病队列(CKD-JAC)研究的横断面队列中测量了左心室质量指数(LVMI),以确定与3-5期CKD患者LVMI升高相关的因素。

结果

我们分析了1088名参与者的基线特征(男性63.8%,女性36.2%)。41.7%的患者基础疾病为糖尿病,平均年龄为61.8±11.1岁。基线时23.4%的患者检测到LVH。通过多因素逻辑分析,LVH的独立危险因素为心血管疾病病史[比值比(OR)2.364;95%置信区间(CI)1.463-3.822;P = 0.0004]、体重指数(OR 1.108;95%CI 1.046-1.173;P = 0.0005)、收缩压(OR 1.173;95%CI 1.005-1.369;P = 0.0433)、尿白蛋白(OR 1.425;95%CI 1.028-1.974;P = 0.0333)和血清总胆固醇水平(OR 0.994;95%CI 0.989-0.999;P = 0.0174)。

结论

CKD-JAC研究的横断面基线数据揭示了肾功能减退患者LVH与危险因素之间的关联。需要对CKD-JAC队列进行进一步的纵向分析,以评估LVH在CKD患者中的预后价值。

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