Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Atherosclerosis. 2018 Dec;279:107-113. doi: 10.1016/j.atherosclerosis.2018.08.043. Epub 2018 Sep 1.
Despite its strong link to cardiovascular outcomes, the association of chronic kidney disease (CKD) with abdominal aortic aneurysm (AAA) has not been explicitly and comprehensively investigated.
In 10,724 participants in the Atherosclerosis Risk in Communities Study (aged 53-75 years during 1996-1998), we evaluated the associations of two key CKD measures - estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) - with incident AAA (AAA diagnosis in outpatient, hospitalization discharge, or death records). Additionally, we performed a cross-sectional analysis for the CKD measures and ultrasound-based abdominal aortic diameter in 4258 participants during 2011-2013.
During a median follow-up of 13.9 years, 347 participants developed AAA. The demographically-adjusted hazard ratio (HR) was 4.44 (95% CI 1.58-12.49) for eGFR <30, 3.29 (1.89-5.72) for 30-44, 2.03 (1.29-3.19) for 45-59, and 1.62 (1.11-2.35) for 60-74 compared to eGFR ≥90 mL/min/1.73 m and was 2.49 (1.28-4.87) for ACR ≥300, 1.99 (1.40-2.83) for 30-299, and 1.46 (1.08-1.97) for 10-29 compared to ACR <10 mg/g. The associations were generally similar after accounting for additional confounders, such as smoking (although attenuated), or after stratifying by subgroups, including diabetes. The cross-sectional analysis also showed continuous positive associations of these CKD measures with aortic diameter, particularly at the distal aortic segment assessed.
Reduced eGFR and elevated albuminuria were independently associated with greater incidence of AAA and greater abdominal aortic diameter. Our results suggest the potential usefulness of CKD measures to identify persons at high risk of AAA and the need to investigate pathophysiological pathways linking CKD to AAA.
尽管慢性肾脏病（CKD）与腹主动脉瘤（AAA）之间存在密切关联，但目前尚未对其进行明确且全面的研究。
在 10724 名参加动脉粥样硬化风险社区研究（1996-1998 年期间年龄在 53-75 岁之间）的参与者中，我们评估了两种关键的 CKD 指标——估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）——与新发 AAA（AAA 的诊断依据为门诊、住院出院或死亡记录）之间的相关性。此外，我们还对 2011-2013 年期间的 4258 名参与者进行了 CKD 指标和基于超声的腹主动脉直径的横断面分析。
在中位随访 13.9 年期间，347 名参与者发生了 AAA。在调整了人口统计学因素后，eGFR<30 的 HR 为 4.44（95%CI 1.58-12.49），30-44 的 HR 为 3.29（1.89-5.72），45-59 的 HR 为 2.03（1.29-3.19），60-74 的 HR 为 1.62（1.11-2.35），与 eGFR≥90 mL/min/1.73 m 相比；ACR≥300 的 HR 为 2.49（1.28-4.87），30-299 的 HR 为 1.99（1.40-2.83），10-29 的 HR 为 1.46（1.08-1.97），与 ACR<10mg/g 相比。在考虑了其他混杂因素（如吸烟情况，尽管有所减弱），或在按亚组（包括糖尿病）分层后，这些相关性基本保持一致。横断面分析还显示，这些 CKD 指标与主动脉直径呈连续正相关，特别是在评估的远端主动脉节段。
eGFR 降低和白蛋白尿升高与 AAA 的发生率增加和腹主动脉直径增大独立相关。我们的研究结果表明，CKD 指标可能有助于识别 AAA 高危人群，有必要研究 CKD 与 AAA 之间的病理生理途径。
