Department of Internal Medicine Boston Medical Center and Boston University School of Medicine Boston MA.
Department of Epidemiology Boston University School of Public Health Boston MA.
J Am Heart Assoc. 2021 Aug 17;10(16):e020301. doi: 10.1161/JAHA.120.020301. Epub 2021 Aug 13.
Background Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60-89 mL/min per 1.73 m) with cardiovascular disease (CVD) in the community. Methods and Results We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80-89, 70-79, or 60-69 versus ≥90 mL/min per 1.73 m [referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m) using Cox regression. Individuals with eGFR 60-69 mL/min per 1.73 m (n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02-2.80) compared with the referent group. Individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m had higher blood growth differentiating factor-15 concentrations (β=0.131 and 0.058 per unit-increase in log-biomarker, respectively). Participants with eGFR 60-69 and 80-89 mL/min per 1.73 m had higher blood B-type natriuretic peptide concentrations (β=0.119 and 0.116, respectively). On follow-up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60-69 and 70-79 mL/min per 1.73 m experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02-1.93 and 1.45, 95% CI, 1.05-2.00, respectively, versus referent). Participants with eGFR 60-69 mL/min per 1.73 m experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80-4.78 versus referent). Conclusions Individuals with mildly reduced eGFR 60-69 mL/min per 1.73 m have a higher burden of subclinical atherosclerosis cross-sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.
背景数据有限，无法确定社区中肾小球滤过率（eGFR 60-89 mL/min/1.73 m）轻度降低与心血管疾病（CVD）之间的关系。
方法和结果我们评估了 3066 名弗雷明汉后代研究参与者（55%为女性，平均年龄 58 岁），无临床 CVD。使用多变量回归，我们将 eGFR 轻度降低的类别（80-89、70-79 或 60-69 与≥90 mL/min/1.73 m[参考]）与冠状动脉钙、颈动脉内膜中层厚度和左心室肥厚的现患率相关，以及与心脏应激生物标志物的循环浓度相关。我们使用 Cox 回归将 eGFR 类别与 CVD 发生率以及进展至≥慢性肾脏病 3 期（eGFR <60 mL/min/1.73 m）相关联。与参考组相比，eGFR 60-69 mL/min/1.73 m（n=320）的个体具有更高的冠状动脉钙评分（优势比 1.69；95%CI 1.02-2.80）。eGFR 60-69 和 70-79 mL/min/1.73 m 的个体具有更高的生长分化因子-15 浓度（每单位 log 生物标志物增加 0.131 和 0.058）。eGFR 60-69 和 80-89 mL/min/1.73 m 的个体具有更高的 B 型利钠肽浓度（β=0.119 和 0.116）。在随访期间（中位随访 16 年；691 例 CVD 事件和 252 例慢性肾脏病事件），eGFR 60-69 和 70-79 mL/min/1.73 m 的个体发生 CVD 的风险更高（风险比[HR]，1.40；95%CI，1.02-1.93 和 1.45，95%CI，1.05-2.00，分别与参考组相比）。eGFR 60-69 mL/min/1.73 m 的个体发生慢性肾脏病的风险更高（HR，2.94；95%CI，1.80-4.78 与参考组相比）。
结论与 eGFR 60-69 mL/min/1.73 m 轻度降低的个体相比，eGFR 60-69 mL/min/1.73 m 轻度降低的个体具有更高的亚临床动脉粥样硬化负担，并且具有更大的 CVD 和慢性肾脏病进展风险。需要进一步的研究来证实我们的发现。
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