Medical Service Corps of 2nd Armored Brigade, Republic of Korea Army, Paju, South Korea.
Department of Internal Medicine, Nowon Eulji Medical center, Eulji University, Seoul, South Korea.
BMJ Open. 2021 Mar 1;11(3):e043432. doi: 10.1136/bmjopen-2020-043432.
There have been limited studies on the relationship between obstructive spirometry pattern and the development of chronic kidney disease (CKD). We investigated the association between obstructive spirometry pattern and incident CKD development in a large-scale prospective cohort study.
We reviewed the data of 7960 non-CKD adults aged 40-69 years who participated in the Ansung-Ansan cohort, a prospective community-based cohort study. Prebronchodilation results for the ratio of forced expiratory volume per 1 s (FEV1) to forced vital capacity (FVC) were used as the primary exposure. The primary outcome was incident CKD, defined as the first event of an estimated glomerular filtration rate <60 mL/min/1.73 m. HRs and 95% CIs were calculated using multivariate Cox proportional hazard regression analysis.
Over a mean follow-up period of 11.7 years, incident CKD developed in 511 subjects (6.4%). An increase of 0.1 in FEV1/FVC was associated with a decreased risk of incident CKD (HR 0.76, 95% CI 0.68 to 0.84, p<0.001). Compared with the fourth quartile, the HR (95 % CI) of the first quartile of FEV1/FVC ratio was 1.81 (1.39 to 2.36, p<0.001). In the restricted cubic spline curve, the renal hazard associated with a decreased FEV1/FVC ratio was evident at FEV1/FVC values <0.80, showing a U-shaped relationship. In subgroup analysis, the renal hazard associated with a decreased FEV1/FVC ratio was particularly evident in people without metabolic syndrome (p for interaction=0.018).
Decreased FEV1/FVC ratio was independently associated with an increased risk of incident CKD development, particularly in people without metabolic syndrome. Future studies need to be conducted to confirm these results.
关于阻塞性肺功能模式与慢性肾脏病（CKD）发展之间的关系，已有研究较少。我们在一项大规模前瞻性队列研究中调查了阻塞性肺功能模式与 CKD 发病之间的关联。
我们回顾了参加安山-安山队列的 7960 名非 CKD 成年人（年龄 40-69 岁）的数据，该队列是一项基于社区的前瞻性队列研究。使用支气管扩张前用力肺活量（FEV1）与用力肺活量（FVC）的比值作为主要暴露因素。主要结局是 CKD 发病，定义为估计肾小球滤过率（eGFR）<60mL/min/1.73m 首次发生的事件。使用多变量 Cox 比例风险回归分析计算 HR 和 95%CI。
在平均 11.7 年的随访期间，511 名受试者（6.4%）发生 CKD。FEV1/FVC 增加 0.1 与 CKD 发病风险降低相关（HR 0.76，95%CI 0.68 至 0.84，p<0.001）。与第四四分位相比，FEV1/FVC 比值的第一四分位的 HR（95%CI）为 1.81（1.39 至 2.36，p<0.001）。在限制立方样条曲线中，FEV1/FVC 比值降低与肾脏危害相关，在 FEV1/FVC 值<0.80 时明显，呈 U 形关系。在亚组分析中，在没有代谢综合征的人群中，FEV1/FVC 比值降低与肾脏危害的相关性尤为明显（p 交互=0.018）。
FEV1/FVC 比值降低与 CKD 发病风险增加独立相关，尤其是在没有代谢综合征的人群中。需要进一步的研究来证实这些结果。
