肾功能与心血管死亡率的关联：一项来自健康检查的老年人群回顾性队列研究。
Association between renal function and cardiovascular mortality: a retrospective cohort study of elderly from health check-up.
机构信息
Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan.
Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
BMJ Open. 2021 Sep 21;11(9):e049307. doi: 10.1136/bmjopen-2021-049307.
OBJECTIVES
This study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function.
DESIGN
A retrospective cohort study.
SETTING
Community-based health examination database from Taipei city.
PARTICIPANTS
At the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses.
PRIMARY OUTCOME MEASURES
Kidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ -5 mL/min/1.73 m per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality.
RESULTS
In this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/-, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality.
CONCLUSIONS
Renal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.
目的
本研究旨在探讨老年亚洲人心血管死亡率与肾功能下降之间的关系。
设计
回顾性队列研究。
地点
台北市社区健康检查数据库。
参与者
在研究开始时，数据库包含了 2005 年至 2012 年期间 97803 名 65 岁以上老年人的 315045 次健康检查访问。排除缺失值和异常值后，保留了至少两次就诊的 64732 名老年人进行进一步分析。
主要观察指标
肾脏功能指标包括估算肾小球滤过率（eGFR）和尿蛋白，eGFR 快速下降定义为斜率≤-5mL/min/1.73m/年。终点结局定义为国际疾病分类编码的死亡登记册中记录的心血管死亡。我们应用 Cox 比例风险模型分析肾脏功能与心血管死亡率之间的关系。
结果
在这项研究中，我们发现 1264 名老年人死于心血管疾病，其中包括 4055 次之前的健康检查。我们观察到 eGFR<60mL/min/1.73m（男性 eGFR>60>eGFR≥45 和 eGFR<45 的 HR（95%CI）为 2.85（1.33 至 6.09）和 3.98（1.84 至 8.61）；女性为 3.66（1.32 至 10.15）和 6.77（2.41 至 18.99））、阳性蛋白尿（男性+/-, +,++和++++，++++的 HR（95%CI）为 1.51（1.29 至 1.78）和 2.31（1.51 至 3.53）；女性为 1.93（1.54 至 2.42）和 4.23（2.34 至 7.65））和 eGFR 快速下降（男性 HR（95%CI）为 3.24（2.73 至 3.85）；女性为 2.83（2.20 至 3.64）与心血管死亡率风险增加相关。尿液蛋白浓度增加和 eGFR 降低的联合效应与心血管死亡率风险增加相关。
结论
肾脏功能和肾功能快速下降是老年人心血管死亡率的独立危险因素。
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