Divisions of Nephrology and.
General Medicine, Department of Internal Medicine and.
Clin J Am Soc Nephrol. 2019 Aug 7;14(8):1133-1141. doi: 10.2215/CJN.01740219. Epub 2019 Jul 23.
CKD is a global public health problem. Some cross-sectional studies have associated environmental melamine exposure with kidney diseases, but evidence is limited.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted this prospective cohort study to enroll patients with eGFR≥30 ml/min per 1.73 m in 2006-2010. Urinary corrected melamine levels (ratio of urinary melamine to urinary creatinine) were measured by liquid chromatography/tandem mass spectrometry at enrollment. Kidney outcomes included doubling of serum creatinine levels, eGFR decline >3 ml/min per 1.73 m per year, and 30% decline in eGFR in the first 2 years. Subjects were followed until targeted kidney outcomes, cancer, death, last contact, or the end of observation in December 2016.
In a total of 293 subjects, the median urinary corrected melamine level was 0.97 (interquartile range, 0.43-2.08) g/mmol. Over a median follow-up period of 7.0 years, serum creatinine levels doubled in 80 subjects (27%). Subjects in the highest tertile of urinary melamine level 12.70 g/mmol) had a 2.30 (95% confidence interval, 1.25 to 4.23; <0.01) hazard risk for doubling of serum creatinine compared with those in the lowest tertile (0.02-0.58 g/mmol). Similar significant dose-response results were found in eGFR decline >3 ml/min per 1.73 m per year and 30% decline in eGFR in the first 2 years.
Urinary melamine level is significantly associated with kidney function deterioration in patients with early-stage CKD.
慢性肾脏病（CKD）是一个全球性的公共卫生问题。一些横断面研究表明，环境三聚氰胺暴露与肾脏疾病有关，但证据有限。
设计、设置、参与者和测量方法：我们进行了这项前瞻性队列研究，以招募 2006 年至 2010 年 eGFR≥30 ml/min/1.73 m 的患者。在入组时通过液相色谱/串联质谱法测量尿液校正三聚氰胺水平（尿液三聚氰胺与尿液肌酐的比值）。肾脏结局包括血清肌酐水平翻倍、eGFR 每年下降>3 ml/min/1.73 m 和前 2 年 eGFR 下降 30%。在达到目标肾脏结局、癌症、死亡、最后一次联系或 2016 年 12 月观察结束之前，对受试者进行随访。
在总共 293 名受试者中，尿液校正三聚氰胺水平的中位数为 0.97（四分位间距，0.43-2.08）g/mmol。在中位随访 7.0 年期间，80 名受试者（27%）的血清肌酐水平翻倍。与最低三分位组（0.02-0.58 g/mmol）相比，尿液三聚氰胺水平最高三分位组（12.70 g/mmol）的血清肌酐翻倍风险比为 2.30（95%置信区间，1.25 至 4.23；<0.01）。在 eGFR 每年下降>3 ml/min/1.73 m 和前 2 年 eGFR 下降 30%方面也发现了类似的显著剂量反应结果。
尿液三聚氰胺水平与早期 CKD 患者的肾功能恶化显著相关。
