Department of Preventive Medicine, Chonnam National University Medical School, 264, Seoyang‑ro Hwasun‑eup, Hwasun, Jeollanam-do, 58128, Republic of Korea; Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
Department of Preventive Medicine, Chonnam National University Medical School, 264, Seoyang‑ro Hwasun‑eup, Hwasun, Jeollanam-do, 58128, Republic of Korea.
Maturitas. 2021 Jan;143:178-183. doi: 10.1016/j.maturitas.2020.10.016. Epub 2020 Nov 2.
To assess the associations among the estimated glomerular filtration rate (eGFR), albumin to creatinine ratio (ACR), and all-cause and CVD mortality rate and to compare the performances of eGFR, eGFR, and eGFR using receiver operating characteristic (ROC) analysis in Korean adults aged ≥ 50 years.
Of the 9,260 subjects who participated in the baseline survey of a prospective longitudinal study conducted in Korea, 9,009 (men: 3,574 (39.7%); women: 5,435 (60.3%)) were included in this analysis after the exclusion of 217 subjects with missing eGFR and 34 subjects with missing ACR data.
The associations of eGFR and ACR with all-cause and CVD mortality were investigated using Cox proportional hazards models that included sex, age, waist circumference, smoking, alcohol intake, degree of physical activity, hypertension, diabetes, systolic blood pressure, log-HbA, total cholesterol, log-triglyceride, log-HDL and log-ACR or eGFR.
After adjustment for covariates, independent associations were found between all-cause mortality and the eGFR (mL/min per 1.73 m) [HR 1.23, 95% confidence interval (CI) 1.05-1.43 for 60-89 vs. ≥ 90; HR 1.87, 95% CI 1.49-2.34 for 45-59 vs. ≥ 90; HR 2.38, 95% CI 1.77-3.20 for 30-44 vs. ≥ 90; HR 2.82, 95% CI 1.89-4.23 for <30 vs. ≥ 90] and ACR (μg/mg creatinine) [HR 1.09, 95% CI 0.88-1.34 for Q2 vs. Q1; HR 1.34, 95% CI 1.10-1.63 for Q3 vs. Q1; HR 1.49, 95% CI 1.22-1.81 for Q4 vs. Q1]. In addition, independent associations of CVD mortality with the eGFR and ACR were significant. In the comparison of eGFR performance, the ROC-plot AUC for all-cause mortality was significantly greater for the eGFR than for the eGFR and eGFR.
The eGFR and ACR were associated independently with all-cause and CVD mortality after adjustment for covariates, including the eGFR and ACR. In addition, the ROC-plot AUC for all-cause mortality was greater for the eGFR than for the eGFR and eGFR in Korean adults aged ≥ 50 years.
评估估算肾小球滤过率（eGFR）、白蛋白与肌酐比值（ACR）与全因和心血管疾病死亡率之间的关联，并通过接收者操作特征（ROC）分析比较 eGFR、eGFR 和 eGFR 在≥50 岁韩国成年人中的表现。
在韩国进行的一项前瞻性纵向研究的基线调查中，有 9260 名受试者参加，排除了 217 名 eGFR 缺失和 34 名 ACR 数据缺失的受试者后，共有 9009 名受试者（男性：3574 名（39.7%）；女性：5435 名（60.3%））纳入本分析。
使用包含性别、年龄、腰围、吸烟、饮酒、身体活动程度、高血压、糖尿病、收缩压、log-HbA、总胆固醇、log-甘油三酯、log-HDL 和 log-ACR 或 eGFR 的 Cox 比例风险模型，调查 eGFR 和 ACR 与全因和心血管疾病死亡率的相关性。
在调整协变量后，发现全因死亡率与 eGFR（mL/min per 1.73 m）之间存在独立关联[60-89 岁 vs. ≥90 岁的 HR 为 1.23，95%置信区间（CI）为 1.05-1.43；45-59 岁 vs. ≥90 岁的 HR 为 1.87，95%CI 为 1.49-2.34；30-44 岁 vs. ≥90 岁的 HR 为 2.38，95%CI 为 1.77-3.20；<30 岁 vs. ≥90 岁的 HR 为 2.82，95%CI 为 1.89-4.23]和 ACR（μg/mg 肌酐）[Q2 与 Q1 相比的 HR 为 1.09，95%CI 为 0.88-1.34；Q3 与 Q1 相比的 HR 为 1.34，95%CI 为 1.10-1.63；Q4 与 Q1 相比的 HR 为 1.49，95%CI 为 1.22-1.81]。此外，CVD 死亡率与 eGFR 和 ACR 之间的独立关联也具有统计学意义。在比较 eGFR 性能时，eGFR 与 eGFR 和 eGFR 相比，全因死亡率的 ROC 曲线 AUC 显著更大。
在调整包括 eGFR 和 ACR 在内的协变量后，eGFR 和 ACR 与全因和心血管疾病死亡率独立相关。此外，在≥50 岁的韩国成年人中，eGFR 与 eGFR 和 eGFR 相比，全因死亡率的 ROC 曲线 AUC 更大。
