血清尿酸升高与肾功能快速下降相关：一项10年随访研究
Elevated Serum Uric Acid is Associated with Rapid Decline in Kidney Function: A 10-Year Follow-Up Study.
作者信息
Kritmetapak Kittrawee, Charoensri Suranut, Thaopanya Rattrai, Pongchaiyakul Chatlert
机构信息
Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
出版信息
Int J Gen Med. 2020 Oct 23;13:945-953. doi: 10.2147/IJGM.S277957. eCollection 2020.
PURPOSE
The long-term impact of changes in serum uric acid (SUA) concentration on the estimated glomerular filtration rate (eGFR) among the general population remains unclear. We investigated the longitudinal associations between changes in SUA and eGFR over 10 years in 1222 participants with baseline eGFR ≥60 mL/min/1.73 m.
METHODS
This was a 10-year retrospective cohort study conducted from 2007 to 2017. Rapid eGFR decline (defined as the highest quartile of change in eGFR between 2007 and 2017) and new-onset kidney disease (defined as an eGFR <60 mL/min/1.73 m at a 10-year follow-up) were examined using multiple logistic regression analysis, adjusted for sex, age, body mass index, systolic blood pressure, SUA, fasting plasma glucose, serum total cholesterol, and triglyceride at baseline.
RESULTS
SUA was inversely correlated with eGFR, and the slopes of the SUA-eGFR regression lines were consistently steeper in females than males. A significant inverse correlation was also observed between 10-year changes in SUA and eGFR in both sexes. Multivariate analysis showed that every 1 mg/dL increase in SUA from baseline was associated with higher risk of rapid eGFR decline and new-onset kidney disease (OR 1.25; 95% CI 1.14-1.33 and OR 1.40; 95% CI 1.26-1.49, respectively). Furthermore, the subjects in the highest SUA quartile (>6.0 mg/dL) had a 2.45 times higher risk of rapid eGFR decline (95% CI 1.51-3.42) compared to those in the lowest SUA quartile (<3.9 mg/dL).
CONCLUSION
Elevated baseline SUA is an independent risk factor for rapid eGFR decline and new-onset kidney disease in the general population.
目的
血清尿酸（SUA）浓度变化对普通人群估算肾小球滤过率（eGFR）的长期影响尚不清楚。我们调查了1222名基线eGFR≥60 mL/min/1.73 m²的参与者在10年中SUA变化与eGFR之间的纵向关联。
方法
这是一项从2007年至2017年进行的为期10年的回顾性队列研究。使用多因素逻辑回归分析来检验快速eGFR下降（定义为2007年至2017年期间eGFR变化的最高四分位数）和新发肾病（定义为10年随访时eGFR<60 mL/min/1.73 m²），并对基线时的性别、年龄、体重指数、收缩压、SUA、空腹血糖、血清总胆固醇和甘油三酯进行校正。
结果
SUA与eGFR呈负相关，且女性SUA - eGFR回归线的斜率始终比男性更陡。在两性中，还观察到SUA的10年变化与eGFR之间存在显著的负相关。多变量分析显示，与基线相比，SUA每升高1 mg/dL与快速eGFR下降和新发肾病的风险更高相关（分别为OR 1.25；95%CI 1.14 - 1.33和OR 1.40；95%CI 1.26 - 1.49）。此外，与SUA最低四分位数（<3.9 mg/dL）的受试者相比，SUA最高四分位数（>6.0 mg/dL）的受试者快速eGFR下降的风险高2.45倍（95%CI 1.51 - 3.42）。
结论
基线SUA升高是普通人群快速eGFR下降和新发肾病的独立危险因素。
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