Lee Hye Sun, Lim Hong Il, Moon Tae Ju, Lee So Young, Lee Jun-Hyuk
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, 03277, Republic of Korea.
Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea.
BMC Nephrol. 2024 Apr 22;25(1):141. doi: 10.1186/s12882-024-03583-1.
The relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up.
We analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m.
During a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74-2.62) in the unadjusted model and 1.35 (1.02-1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group.
An increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.
动脉粥样硬化与肾功能之间的关系已得到充分证实。动脉粥样硬化性心血管疾病（ASCVD）风险评分反映了动脉粥样硬化负担，而这种负担会随时间变化。我们利用来自一个大型韩国社区队列的数据，进行了长达16年的随访，以研究ASCVD风险轨迹与新发慢性肾脏病（CKD）之间的关联。
我们分析了韩国基因组与流行病学研究安山-安城队列基线调查中5032名无CKD参与者的数据。根据修订后的ASCVD风险合并队列方程，在中位暴露期5.8年的时间里，将参与者分为ASCVD风险稳定或增加的组。新发CKD定义为估算肾小球滤过率<60 mL/min/1.73 m²的连续两次事件。
在中位9.9年的事件累积期内，共确定了449例（8.92%）新发CKD病例。多项Cox比例回归分析显示，在未调整模型中，与稳定组相比，风险增加组发生CKD的风险比（95%置信区间）为2.13（1.74 - 2.62），在完全调整模型中为1.35（1.02 - 1.78）。在50多岁、无糖尿病或高血压的个体亚组中，这种显著关系依然存在。风险增加组的蛋白尿患病率始终高于稳定组。
ASCVD风险评分的上升趋势独立预测了无糖尿病或高血压患者的不良肾脏结局。持续监测ASCVD风险不仅对预测心血管疾病很重要，对预测CKD也很重要。
