National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China.
National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute for Biomedicine, Anhui Medical University, Hefei, China.
Clin Nutr. 2020 Jan;39(1):258-264. doi: 10.1016/j.clnu.2019.02.002. Epub 2019 Feb 14.
BACKGROUND & AIMS: We aimed to examine the association between serum albumin (SAlb) and the development of chronic kidney disease (CKD), and examine any possible effect modifiers in general hypertensive patients with normal renal function and with no previous cardiovascular diseases (CVD).
This is a post-hoc analysis (performed at May, 2018) of 12,621 hypertensive adults with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m and SAlb ≥35.0 g/L from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT), conducted from May 2008 to August 2013. The primary outcome was development of CKD, defined as a decrease in eGFR of ≥30% and to a level of <60 mL/min/1.73 m; or end stage renal disease.
The median follow-up duration was 4.4 years. Overall, the association between SAlb levels and risk of the primary outcome followed a U-shape. The risk of CKD development significantly decreased with the increment of SAlb (per g/L: OR = 0.92; 95% CI: 0.88-0.96) in participants with SAlb <51.4 g/L, and increased with the increment of SAlb (per g/L: OR = 1.06; 95%CI: 1.01-1.11) in participants with SAlb ≥51.4 g/L. Moreover, in participants with SAlb <51.4 g/L, the association between SAlb and CKD development remained significant in participants without proteinuria (per g/L: OR = 0.93; 95% CI: 0.88-0.99). The association between SAlb and CKD development was not significantly modified by age, sex, folic acid treatment, proteinuria, systolic blood pressure (SBP) at baseline and time-averaged SBP during the treatment period (all P-interactions>0.05).
There was a U-shaped association between SAlb levels and risk of CKD development among general hypertensive patients with normal renal function and without CVD, with a turning point at about 51.4 g/L.
本研究旨在探讨血清白蛋白（SAlb）与慢性肾脏病（CKD）发展之间的关系，并在肾功能正常且无既往心血管疾病（CVD）的一般高血压患者中，探讨可能的效应修饰因子。
这是中国脑卒中一级预防试验（CSPPT）肾脏子研究的事后分析（于 2018 年 5 月进行），共纳入 12621 名估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m 且 SAlb≥35.0 g/L 的高血压成年人，研究时间为 2008 年 5 月至 2013 年 8 月。主要结局为 CKD 的发展，定义为 eGFR 下降≥30%至<60 mL/min/1.73 m，或终末期肾病。
中位随访时间为 4.4 年。总体而言，SAlb 水平与主要结局风险之间呈 U 型关系。在 SAlb<51.4 g/L 的患者中，随着 SAlb 的增加（每 g/L：OR=0.92；95%CI：0.88-0.96），CKD 发展的风险显著降低，而在 SAlb≥51.4 g/L 的患者中，随着 SAlb 的增加（每 g/L：OR=1.06；95%CI：1.01-1.11），CKD 发展的风险增加。此外，在 SAlb<51.4 g/L 的患者中，在无蛋白尿的患者中，SAlb 与 CKD 发展之间的关联仍然显著（每 g/L：OR=0.93；95%CI：0.88-0.99）。SAlb 与 CKD 发展之间的关联在年龄、性别、叶酸治疗、蛋白尿、基线收缩压（SBP）和治疗期间的平均 SBP 方面没有显著改变（所有 P 交互作用>0.05）。
在肾功能正常且无 CVD 的一般高血压患者中，SAlb 水平与 CKD 发展风险之间呈 U 型关系，拐点约为 51.4 g/L。
