非透析慢性肾脏病患者尿氯排泄与冠状动脉钙化进展的关系：KNOW-CKD研究结果
Association between urinary chloride excretion and progression of coronary artery calcification in patients with nondialysis chronic kidney disease: results from the KNOW-CKD study.
作者信息
Suh Sang Heon, Oh Tae Ryom, Choi Hong Sang, Kim Chang Seong, Bae Eun Hui, Ma Seong Kwon, Oh Kook-Hwan, Yoo Tae-Hyun, Chae Dong-Wan, Kim Soo Wan
机构信息
Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
出版信息
Kidney Res Clin Pract. 2023 Mar;42(2):251-261. doi: 10.23876/j.krcp.22.072. Epub 2023 Mar 13.
BACKGROUND
Urine chloride has recently been suggested as a biomarker of renal tubule function in patients with nondialysis chronic kidney disease (CKD), as low urinary chloride concentration is associated with an increased risk of CKD progression. We investigate the association between urinary chloride excretion and the progression of coronary artery calcification (CAC).
METHODS
A total of 1,065 patients with nondialysis CKD were divided into tertiles by spot urine chloride-to-creatinine ratios. The 1st, 2nd, and 3rd tertiles were defined as low, moderate, and high urinary chloride excretion, respectively. The study outcome was CAC progression, which was defined as an increase in coronary artery calcium score of more than 200 Agatston units during the 4-year follow-up period.
RESULTS
Compared to moderate urinary chloride excretion, high urinary chloride excretion was associated with decreased risk of CAC progression (adjusted odds ratio, 0.379; 95% confidence interval, 0.190-0.757), whereas low urinary chloride excretion was not associated with risk of CAC progression. Restricted cubic spine depicted an inverted J-shaped curve, with a significant reduction in the risk of CAC progression in subjects with high spot urine chloride-to-creatinine ratios.
CONCLUSION
High urinary chloride excretion is associated with decreased risk of CAC progression in patients with nondialysis CKD.
背景
最近有研究表明，尿氯可作为非透析慢性肾脏病（CKD）患者肾小管功能的生物标志物，因为低尿氯浓度与CKD进展风险增加相关。我们研究了尿氯排泄与冠状动脉钙化（CAC）进展之间的关联。
方法
总共1065例非透析CKD患者按随机尿氯与肌酐比值分为三分位数。第1、第2和第3三分位数分别定义为低、中、高尿氯排泄。研究结局为CAC进展，定义为在4年随访期间冠状动脉钙化积分增加超过200阿加西单位。
结果
与中度尿氯排泄相比，高尿氯排泄与CAC进展风险降低相关（校正比值比，0.379；95%置信区间，0.190 - 0.757），而低尿氯排泄与CAC进展风险无关。限制性立方样条图显示为倒J形曲线，随机尿氯与肌酐比值高的受试者CAC进展风险显著降低。
结论
高尿氯排泄与非透析CKD患者CAC进展风险降低相关。
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