Melsom Toralf, Solbu Marit Dahl, Schei Jørgen, Stefansson Vidar Tor Nyborg, Norvik Jon Viljar, Jenssen Trond Geir, Wilsgaard Tom, Eriksen Bjørn Odvar
Metabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway.
Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.
Kidney Int Rep. 2018 Feb 8;3(4):817-824. doi: 10.1016/j.ekir.2018.01.015. eCollection 2018 Jul.
A minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality, but whether it predicts kidney function loss in nondiabetic persons is unclear. We investigated the association between ACR in the optimal or high-normal range and the rate of glomerular filtration rate (GFR) decline in a cohort from the general population without diabetes, cardiovascular, or chronic kidney disease.
In the Renal Iohexol Clearance Survey, we measured GFR using iohexol clearance in 1567 middle-aged nondiabetic individuals with an ACR <3.40 mg/mmol (30.0 mg/g) at baseline. The ACR was measured in unfrozen morning urine samples collected on 3 days before the GFR measurements. A total of 1278 (81%) participants had follow-up with GFR measurements after a median of 5.6 years.
The median ACR at baseline was 0.22 mg/mmol (interquartile range: 0.10-0.51 mg/mmol), the mean ± SD GFR was 104.0 ± 20.1 ml/min, and the mean ± SD GFR decline rate was -0.95 ± 2.23 ml/min per year. Higher baseline ACR levels were associated with a steeper GFR decline in adjusted linear mixed models. Study participants with ACR levels of 0.11 to 0.45 and 0.46 ± 3.40 mg/mmol had a 0.25 ml/min per year (95% confidence interval [95% CI]: -0.03 to 0.53) and 0.31 ml/min per year (95% CI: 0.02-0.60) steeper rate of decline than those with ACR ≤0.10 mg/mmol in multivariable-adjusted analyses. Among study participants with an ACR of <1.13 mg/mmol (defined as the optimal range), those with an ACR of 0.11 to 1.12 mg/mmol (n = 812) had a 0.28 ml/min per year (95% CI: 0.04-0.52) steeper rate of GFR decline than those with an ACR of ≤0.10 mg/mmol (n = 655).
A mildly increased ACR is an independent risk factor for faster GFR decline in nondiabetic individuals.
白蛋白与肌酐比值（ACR）的微小升高可预测心血管疾病和死亡率，但在非糖尿病患者中其是否能预测肾功能丧失尚不清楚。我们在一个无糖尿病、心血管疾病或慢性肾脏病的普通人群队列中，研究了处于最佳或高正常范围的ACR与肾小球滤过率（GFR）下降速率之间的关联。
在肾脏碘海醇清除率调查中，我们对1567名基线ACR<3.40mg/mmol（30.0mg/g）的中年非糖尿病个体，采用碘海醇清除率测量GFR。在测量GFR前3天收集的未冷冻晨尿样本中测量ACR。共有1278名（81%）参与者在中位时间5.6年后进行了GFR测量随访。
基线时ACR的中位数为0.22mg/mmol（四分位间距：0.10 - 0.51mg/mmol），GFR的均值±标准差为104.0±20.1ml/min，GFR下降速率的均值±标准差为每年 - 0.95±2.23ml/min。在调整后的线性混合模型中，较高的基线ACR水平与更陡峭的GFR下降相关。在多变量调整分析中，ACR水平为0.11至0.45和0.46±3.40mg/mmol的研究参与者，其每年下降速率比ACR≤0.10mg/mmol的参与者分别陡峭0.25ml/min（95%置信区间[95%CI]： - 0.03至0.53）和0.31ml/min（95%CI：0.02 - 0.60）。在ACR<1.13mg/mmol（定义为最佳范围）的研究参与者中,ACR为0.11至1.12mg/mmol（n = 812）的参与者，其GFR下降速率比ACR≤0.10mg/mmol（n = 655）的参与者每年陡峭0.28ml/min（95%CI：0.04 -
