Boston Medical Center and Section of Nephrology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts (A.V., S.S.W.).
Boston Medical Center and Section of Nephrology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; and Hamburg Center for Kidney Health, University Medical Center Hamburg, Hamburg, Germany (I.M.S.).
Ann Intern Med. 2024 Apr;177(4):467-475. doi: 10.7326/M23-2814. Epub 2024 Apr 2.
Albuminuria is a major risk factor for chronic kidney disease (CKD) progression, especially when categorized as moderate (30 to 300 mg/g) or severe (>300 mg/g). However, there are limited data on the prognostic value of albuminuria within the normoalbuminuric range (<30 mg/g) in persons with CKD.
To estimate the increase in the cumulative incidence of CKD progression with greater baseline levels of albuminuria among persons with CKD who had normoalbuminuria (<30 mg/g).
Multicenter prospective cohort study.
7 U.S. clinical centers.
1629 participants meeting criteria from the CRIC (Chronic Renal Insufficiency Cohort) study with CKD (estimated glomerular filtration rate [eGFR], 20 to 70 mL/min/1.73 m) and urine albumin-creatinine ratio (UACR) less than 30 mg/g.
Baseline spot urine albumin divided by spot urine creatinine to calculate UACR as the exposure variable. The 10-year adjusted cumulative incidences of CKD progression (composite of 50% eGFR decline or kidney failure [dialysis or kidney transplantation]) from confounder adjusted survival curves using the G-formula.
Over a median follow-up of 9.8 years, 182 of 1629 participants experienced CKD progression. The 10-year adjusted cumulative incidences of CKD progression were 8.7% (95% CI, 5.9% to 11.6%), 11.5% (CI, 8.8% to 14.3%), and 19.5% (CI, 15.4% to 23.5%) for UACR levels of 0 to less than 5 mg/g, 5 to less than 15 mg/g, and 15 mg/g or more, respectively. Comparing persons with UACR 15 mg/g or more to those with UACR 5 to less than 15 mg/g and 0 to less than 5 mg/g, the absolute risk differences were 7.9% (CI, 3.0% to 12.7%) and 10.7% (CI, 5.8% to 15.6%), respectively. The 10-year adjusted cumulative incidence increased linearly based on baseline UACR levels.
UACR was measured once.
Persons with CKD and normoalbuminuria (<30 mg/g) had excess risk for CKD progression, which increased in a linear fashion with higher levels of albuminuria.
None.
白蛋白尿是慢性肾脏病（CKD）进展的一个主要危险因素，尤其是当白蛋白尿被归类为中度（30 至 300 毫克/克）或重度（>300 毫克/克）时。然而，在 CKD 患者中，正常白蛋白尿范围内（<30 毫克/克）白蛋白尿的预后价值数据有限。
估计在具有正常白蛋白尿（<30 毫克/克）的 CKD 患者中，基线白蛋白尿水平较高时，CKD 进展的累积发生率增加。
多中心前瞻性队列研究。
美国 7 个临床中心。
符合 CRIC（慢性肾功能不全队列）研究标准的 1629 名 CKD 患者（估计肾小球滤过率[eGFR]为 20 至 70 毫升/分钟/1.73 米），尿液白蛋白/肌酐比值（UACR）低于 30 毫克/克。
用斑点尿白蛋白除以斑点尿肌酐计算 UACR 作为暴露变量。使用 G 公式从混杂因素调整后的生存曲线计算 CKD 进展（eGFR 下降 50%或肾衰竭[透析或肾移植]的复合）的 10 年调整累积发生率。
在中位随访 9.8 年期间，1629 名参与者中有 182 名发生 CKD 进展。UACR 水平分别为 0 至小于 5 毫克/克、5 至小于 15 毫克/克和 15 毫克/克或更高时，10 年调整的 CKD 进展累积发生率分别为 8.7%（95%CI，5.9%至 11.6%）、11.5%（CI，8.8%至 14.3%）和 19.5%（CI，15.4%至 23.5%）。将 UACR 水平为 15 毫克/克或更高的患者与 UACR 水平为 5 至小于 15 毫克/克和 0 至小于 5 毫克/克的患者进行比较，绝对风险差异分别为 7.9%（CI，3.0%至 12.7%）和 10.7%（CI，5.8%至 15.6%）。基于基线 UACR 水平，10 年调整的累积发生率呈线性增加。
UACR 仅测量一次。
患有 CKD 和正常白蛋白尿（<30 毫克/克）的患者发生 CKD 进展的风险增加，且随着白蛋白尿水平的升高呈线性增加。
无。
