血清白蛋白水平与慢性肾脏病患者的肾脏预后和肾功能下降有关。
The level of serum albumin is associated with renal prognosis and renal function decline in patients with chronic kidney disease.
机构信息
Department of Nephrology, Southern University of Science and Technology Hospital, No. 6019 Liuxian Street, Xili Avenue, Nanshan District, Shenzhen, Guangdong Province, 518000, China.
Department of Nephrology, Hechi People's Hospital, Hechi, Guangxi Zhuang Autonomous Region, 547000, China.
出版信息
BMC Nephrol. 2023 Mar 15;24(1):57. doi: 10.1186/s12882-023-03110-8.
OBJECTIVE
The study's purpose is to explore the link of serum albumin on renal progression in patients with chronic kidney disease (CKD).
METHODS
This study was a secondary analysis of a prospective cohort study in which a total of 954 participants were non-selectively and consecutively collected from the research of CKD-ROUTE in Japan between November 2010 and December 2011. We evaluated the association between baseline ALB and renal prognosis (initiation of dialysis or 50% decline in eGFR from baseline) and renal function decline (annual eGFR decline) using the Cox proportional-hazards and linear regression models, respectively. We performed a number of sensitivity analyses to ensure the validity of the results. In addition, we performed subgroup analyses.
RESULTS
The included patients had a mean age of (66.86 ± 13.41) years, and 522 (69.23%) were male. The mean baseline ALB and eGFR were (3.89 ± 0.59) g/dL and (33.43 ± 17.97) ml/min/1.73 m. The annual decline in eGFR was 2.65 mL/min/1.73 m/year. 218 (28.9%) individuals experienced renal prognosis during a median follow-up period of 36.0 months. The baseline ALB was inversely linked with renal prognosis (HR = 0.61, 95%CI: 0.45, 0.81) and renal function decline (β = -1.41, 95%CI: -2.11, -0.72) after controlling for covariates. The renal prognosis and ALB had a non-linear connection, with ALB's inflection point occurring at 4.3 g/dL. Effect sizes (HR) were 0.42 (0.32, 0.56) and 6.11 (0.98, 38.22) on the left and right sides of the inflection point, respectively. There was also a non-linear relationship between ALB and renal function decline, and the inflection point of ALB was 4.1 g/dL. The effect sizes(β) on the left and right sides of the inflection point were -2.79(-3.62, -1.96) and 0.02 (-1.97, 1.84), respectively.
CONCLUSION
This study shows a negative and non-linear association between ALB and renal function decline as well as renal prognosis in Japanese CKD patients. When ALB is lower than 4.1 g/dL, ALB decline was closely related to poor renal prognosis and renal function decline. From a therapeutic point of view, reducing the decline in ALB makes sense for delaying CKD progression.
目的
本研究旨在探讨慢性肾脏病（CKD）患者血清白蛋白与肾脏进展的关系。
方法
本研究是一项前瞻性队列研究的二次分析，于 2010 年 11 月至 2011 年 12 月期间在日本 CKD-ROUTE 研究中连续非选择性地收集了 954 名参与者。我们分别使用 Cox 比例风险和线性回归模型评估基线 ALB 与肾脏预后（开始透析或 eGFR 从基线下降 50%）和肾功能下降（eGFR 年下降）之间的关联。我们进行了多项敏感性分析以确保结果的有效性。此外，我们进行了亚组分析。
结果
纳入的患者平均年龄为（66.86±13.41）岁，522 名（69.23%）为男性。基线 ALB 和 eGFR 的平均值分别为（3.89±0.59）g/dL 和（33.43±17.97）ml/min/1.73 m。eGFR 的年下降率为 2.65 ml/min/1.73 m/年。在中位随访 36.0 个月期间，218 名（28.9%）患者出现肾脏预后。在校正协变量后，基线 ALB 与肾脏预后（HR=0.61，95%CI：0.45，0.81）和肾功能下降（β=-1.41，95%CI：-2.11，-0.72）呈负相关。肾脏预后和 ALB 之间存在非线性关系，ALB 的拐点出现在 4.3 g/dL。拐点左侧和右侧的效应大小（HR）分别为 0.42（0.32，0.56）和 6.11（0.98，38.22）。ALB 与肾功能下降之间也存在非线性关系，ALB 的拐点为 4.1 g/dL。拐点左侧和右侧的效应大小（β）分别为-2.79（-3.62，-1.96）和 0.02（-1.97，1.84）。
结论
本研究表明，日本 CKD 患者的 ALB 与肾功能下降以及肾脏预后呈负性和非线性关系。当 ALB 低于 4.1 g/dL 时，ALB 下降与不良肾脏预后和肾功能下降密切相关。从治疗角度来看，降低 ALB 的下降速度对延缓 CKD 进展有意义。
Zotero 插件