Liu Mengyi, He Panpan, Zhou Chun, Zhang Zhuxian, Zhang Yuanyuan, Li Huan, Liu Chengzhang, Nie Jing, Liang Min, Qin Xianhui
Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.
Clin Kidney J. 2022 Jan 8;15(6):1093-1099. doi: 10.1093/ckj/sfac002. eCollection 2022 Jun.
The longitudinal relationship of albuminuria with incident frailty remains unknown. Therefore we aimed to evaluate the relation of albuminuria with the risk of incident frailty in older adults.
A total of 1115 participants ≥65 years of age (average age 80.3 years) who were free of frailty in the Chinese Longitudinal Healthy Longevity Survey were included. The outcome was incident frailty, defined as a frailty index ≥0.25 during follow-up. Cox proportional hazards models were used to assess the association of the urinary albumin:creatinine ratio (UACR) with frailty.
During a median follow-up duration of 5.3 years, 295 (26.5%) participants developed incident frailty. Overall, the UACR was significantly positively associated with the risk of incident frailty (P for trend = 0.005), with a significantly higher risk of incident frailty in participants in the quartile 4 of UACR {≥13.43 mg/g; hazard ratio [HR] 1.64 [95% confidence interval (CI) 1.13-2.37]} compared with those in quartile 1 (<0.73 mg/g). Consistently, when UACRs were assessed as clinical categories, compared with participants with UACR <10 mg/g, those with UACR ≥30 mg/g had a higher HR of incident frailty [HR 1.61 (95% CI 1.17-2.20)]. Accounting for the competing risk of death also did not substantially change the results. In addition, a stronger positive association between UACR and incident frailty was found in those with a higher high-sensitivity C-reactive protein level (hs-CRP) (P for interaction = 0.045).
Albuminuria was positively associated with the risk of incident frailty, particularly in those with higher hs-CRP, emphasizing the importance of managing both albuminuria and inflammation for primary prevention of frailty.
蛋白尿与新发衰弱之间的纵向关系尚不清楚。因此，我们旨在评估老年人中蛋白尿与新发衰弱风险之间的关系。
纳入中国长寿老人纵向健康调查中1115名年龄≥65岁（平均年龄80.3岁）且无衰弱的参与者。结局为新发衰弱，定义为随访期间衰弱指数≥0.25。采用Cox比例风险模型评估尿白蛋白与肌酐比值（UACR）与衰弱的关联。
在中位随访期5.3年期间，295名（26.5%）参与者出现新发衰弱。总体而言，UACR与新发衰弱风险呈显著正相关（趋势P=0.005），UACR四分位数4组（≥13.43mg/g；风险比[HR]1.64[95%置信区间（CI）1.13-2.37]）的参与者发生新发衰弱的风险显著高于四分位数1组（<0.73mg/g）。同样，当将UACR评估为临床类别时，与UACR<10mg/g的参与者相比，UACR≥30mg/g的参与者发生新发衰弱的HR更高[HR 1.61（95%CI 1.17-2.20）]。考虑死亡的竞争风险也未实质性改变结果。此外，在高敏C反应蛋白水平（hs-CRP）较高的人群中，UACR与新发衰弱之间的正相关更强（交互作用P=0.045）。
蛋白尿与新发衰弱风险呈正相关，尤其是在hs-CRP较高的人群中，这强调了管理蛋白尿和炎症对于衰弱一级预防的重要性。
