Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
Clin Exp Nephrol. 2020 May;24(5):435-443. doi: 10.1007/s10157-019-01842-2. Epub 2020 Feb 19.
BACKGROUND: Albuminuria and estimated glomerular filtration rate (eGFR) are clinically measured to evaluate the severity of chronic kidney disease (CKD). The aim of our study was to clarify the association between clinical parameters, including albuminuria and eGFR, and the risk of incident CKD in a nondiabetic population with normal range of albuminuria and eGFR. METHODS: A 10-year follow-up, retrospective cohort study involving 317 Japanese men (mean age, 42 years) with eGFR ≥ 90 mL/min/1.73 m and urine albumin-to-creatinine ratio (UACR) < 30 mg/gCr was performed. Participants were free of diabetes mellitus. Multivariate logistic regression approaches were used to assess independent predictors of the incidence of CKD. RESULTS: Twenty-nine (9%) participants developed CKD (eGFR < 60 mL/min/1.73 m and/or UACR ≥ 30 mg/gCr) through 10 years of follow-up. At the baseline examination, age, blood pressure, UACR, and eGFR were higher in participants who developed CKD than in those without CKD. After adjustment for confounders, high-normal albuminuria (P < 0.001) and hypertension (P = 0.045) were associated with an increased incidence of CKD. From receiver-operating characteristic curves, UACR ≥ 7.0 mg/gCr was defined as high-normal albuminuria. Logistic regression analysis also showed that, in addition to presence of hypertension, UACR ≥ 7.0 mg/gCr was identified as an independent risk of incident CKD within 10 years after adjustment for age, body mass index, smoking status, and dyslipidemia [UACR: odds ratio (OR) 17.36 (95% CI 6.16-48.93, P < 0.001)]. CONCLUSION: High-normal albuminuria and hypertension are associated with incident CKD in a nondiabetic population with normal-range UACR and eGFR.
背景:白蛋白尿和估算肾小球滤过率(eGFR)是临床上用于评估慢性肾脏病(CKD)严重程度的指标。我们的研究旨在阐明在白蛋白尿和 eGFR 处于正常范围内的非糖尿病人群中,包括白蛋白尿和 eGFR 在内的临床参数与 CKD 发病风险之间的关系。
方法:对 317 名日本男性(平均年龄 42 岁)进行了 10 年的随访、回顾性队列研究,这些男性的 eGFR≥90mL/min/1.73m,且尿白蛋白与肌酐比值(UACR)<30mg/gCr。参与者均无糖尿病。采用多变量逻辑回归方法评估 CKD 发病的独立预测因素。
结果:在 10 年的随访中,有 29 名(9%)参与者发生了 CKD(eGFR<60mL/min/1.73m 和/或 UACR≥30mg/gCr)。在基线检查时,与未发生 CKD 的参与者相比,发生 CKD 的参与者的年龄、血压、UACR 和 eGFR 更高。在校正混杂因素后,高正常白蛋白尿(P<0.001)和高血压(P=0.045)与 CKD 发病率的增加相关。来自受试者工作特征曲线的结果显示,UACR≥7.0mg/gCr 被定义为高正常白蛋白尿。Logistic 回归分析还表明,除了高血压外,UACR≥7.0mg/gCr 也是在调整年龄、体重指数、吸烟状况和血脂异常后 10 年内发生 CKD 的独立风险因素[UACR:比值比(OR)17.36(95%可信区间 6.16-48.93,P<0.001)]。
结论:在白蛋白尿和 eGFR 处于正常范围内的非糖尿病人群中,高正常白蛋白尿和高血压与 CKD 发病相关。
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