Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.
Division of Internal Medicine, Fukuoka Dental College.
J Atheroscler Thromb. 2024 Nov 1;31(11):1556-1570. doi: 10.5551/jat.64625. Epub 2024 May 11.
Hypertriglyceridemia is a risk factor for chronic kidney disease (CKD). However, whether or not it predicts the risk of CKD progression is unknown. This study evaluated the association between serum triglyceride (TG) levels and kidney disease progression in patients with non-dialysis-dependent CKD.
The Fukuoka Kidney disease Registry (FKR) study was a multicenter, prospective longitudinal cohort study. In total, 4,100 patients with CKD were followed up for 5 years. The primary outcome was the incidence of CKD progression, defined as a ≥ 1.5-fold increase in serum creatinine level or the development of end-stage kidney disease. The patients were divided into quartiles according to baseline serum TG levels under non-fasting conditions: Q1 ＜87 mg/dL; Q2, 87-120 mg/dL; Q3, 121-170 mg/dL, and Q4 ＞170 mg/dL.
During the 5-year observation period, 1,410 patients met the criteria for CKD progression. The multivariable-adjusted Cox proportional hazards model showed a significant association between high serum TG level and the risk of CKD progression in the model without macroalbuminuria as a covariate (multivariable hazard ratio[HR] for Q4 versus Q1, 1.20; 95% CI, 1.03-1.41; P=0.022), but the significance disappeared after adjusting for macroalbuminuria (HR for Q4 versus Q1, 1.06; 95% CI, 0.90-1.24; P=0.507).
The present findings suggest that individuals with high serum TG levels are more likely to develop CKD progression than those without; however, whether or not higher serum TG levels reflect elevated macroalbuminuria or lead to CKD progression via elevated macroalbuminuria is unclear.
高甘油三酯血症是慢性肾脏病（CKD）的一个危险因素。然而，它是否预测 CKD 进展的风险尚不清楚。本研究评估了非透析依赖性 CKD 患者血清甘油三酯（TG）水平与肾脏疾病进展之间的关系。
福冈肾脏病登记研究（FKR）是一项多中心、前瞻性纵向队列研究。共有 4100 例 CKD 患者接受了 5 年的随访。主要结局是 CKD 进展的发生率，定义为血清肌酐水平升高≥1.5 倍或发展为终末期肾病。根据非空腹状态下的基线血清 TG 水平，患者被分为四组：Q1＜87mg/dL；Q2，87-120mg/dL；Q3，121-170mg/dL；Q4＞170mg/dL。
在 5 年观察期内，1410 例患者符合 CKD 进展的标准。多变量调整的 Cox 比例风险模型显示，在没有将大量白蛋白尿作为协变量纳入模型的情况下，高血清 TG 水平与 CKD 进展的风险之间存在显著关联（Q4 与 Q1 相比，多变量风险比[HR]为 1.20；95%可信区间[CI]，1.03-1.41；P=0.022），但在调整大量白蛋白尿后，这种相关性消失（Q4 与 Q1 相比，HR 为 1.06；95%CI，0.90-1.24；P=0.507）。
本研究结果表明，高血清 TG 水平的个体比没有高血清 TG 水平的个体更容易发生 CKD 进展；然而，高血清 TG 水平是否反映了升高的大量白蛋白尿，或者是否通过升高的大量白蛋白尿导致 CKD 进展尚不清楚。
