尿环磷腺苷水平对慢性肾脏病患者预后的影响。
Prognostic impact of urine cyclic AMP levels in patients with chronic kidney disease.
机构信息
The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan.
出版信息
Clin Exp Nephrol. 2022 Dec;26(12):1194-1199. doi: 10.1007/s10157-022-02264-3. Epub 2022 Aug 23.
BACKGROUND
Urine cyclic adenosine monophosphate (cAMP) is a biomarker to assess the residual function of the collecting duct in the kidney. Prognostic implication of urine cAMP levels in patients with chronic kidney disease (CKD) remains unknown.
METHODS
Patients who were followed at our specific outpatient clinic to treat their CKD between December 2015 and December 2019 were included in this prospective study. The impact of urine cAMP levels on the composite of dialysis administration, cardiovascular death, and doubling of serum creatinine concentration was investigated.
RESULTS
A total of 106 patients (median 72 years old, 80 men, and median estimated glomerular filtration rate 28.4 mL/min/1.73 m) were included. Urine cAMP levels ranged widely between 0.35 and 4.08 nmol/mg of creatinine with a median value of 1.99 nmol/mg of creatinine. A urine cAMP level was an independent predictor of the primary endpoint with a hazard ratio of 0.41 (95% confidence interval 0.18-0.91, p = 0.029) adjusted for 5 potential confounders with a cutoff of 1.55 nmol/mg of creatinine.
CONCLUSIONS
A lower urine cAMP is an independent predictor of renal deterioration and cardiovascular death in patients with CKD.
背景
尿环磷酸腺苷（cAMP）是评估肾脏集合管残留功能的生物标志物。尿 cAMP 水平对慢性肾脏病（CKD）患者的预后意义尚不清楚。
方法
本前瞻性研究纳入了 2015 年 12 月至 2019 年 12 月在我院特定门诊接受 CKD 治疗的患者。研究调查了尿 cAMP 水平对透析治疗、心血管死亡和血清肌酐浓度翻倍的复合终点的影响。
结果
共纳入 106 例患者（中位年龄 72 岁，80 名男性，中位估算肾小球滤过率 28.4 ml/min/1.73 m）。尿 cAMP 水平在 0.35 至 4.08 nmol/mg 肌酐之间广泛分布，中位数为 1.99 nmol/mg 肌酐。尿 cAMP 水平是主要终点的独立预测因子，风险比为 0.41（95%置信区间 0.18-0.91，p=0.029），校正了 5 个潜在混杂因素后，截断值为 1.55 nmol/mg 肌酐。
结论
尿 cAMP 降低是 CKD 患者肾脏恶化和心血管死亡的独立预测因子。
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