Claudel Sophie E, Waikar Sushrut S, Schmidt Insa M, Vasan Ramachandran S, Verma Ashish
Department of Medicine, Boston Medical Center, 72 E. Concord Street, Boston, MA 02118, USA.
Section of Nephrology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, X-521, 650 Albany Street, Boston, MA 02118, USA.
Eur J Prev Cardiol. 2024 Dec 4;31(17):2046-2055. doi: 10.1093/eurjpc/zwae189.
The aim of this study is to determine whether elevated levels of albuminuria within the low range [urinary albumin-to-creatinine ratio (UACR) <30 mg/g] are linked to cardiovascular death in adults lacking major cardiovascular risk factors.
The association between UACR and cardiovascular mortality was investigated among 12 835 participants in the 1999-2014 National Health and Nutrition Examination Survey using Cox proportional hazard models and confounder-adjusted survival curves. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, pre-diabetes, an estimated glomerular filtration rate <60 mL/min/1.73 m2, currently pregnant, and those who received dialysis last year. Over a median follow-up of 12.3 years, 110 and 621 participants experienced cardiovascular and all-cause mortality. In multivariable-adjusted models, each doubling of UACR was associated with a 36% higher risk of cardiovascular death [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.02-1.82] and a 24% higher risk of all-cause mortality (HR 1.24, 95% CI 1.10-1.39). The 15-year adjusted cumulative incidences of cardiovascular mortality were 0.91, 0.99, and 2.1% for UACR levels of <4.18, 4.18 to <6.91, and ≥6.91 mg/g, respectively. The 15-year adjusted cumulative incidences of all-cause mortality were 5.1, 6.1, and 7.4% for UACR levels of <4.18, 4.18 to <6.91, and ≥6.91 mg/g, respectively.
Adults with elevated levels of albuminuria within the low range (UACR <30 mg/g) and no major cardiovascular risk factors had elevated risks of cardiovascular and all-cause mortality. The risk increased linearly with higher albuminuria levels. This emphasizes a risk gradient across all albuminuria levels, even within the supposedly normal range, adding to the existing evidence.
本研究旨在确定低水平范围内（尿白蛋白与肌酐比值[UACR]<30mg/g）的蛋白尿水平升高是否与缺乏主要心血管危险因素的成年人的心血管死亡有关。
在1999 - 2014年国家健康与营养检查调查的12835名参与者中，使用Cox比例风险模型和混杂因素调整生存曲线研究UACR与心血管死亡率之间的关联。我们排除了有基线心血管疾病、高血压、糖尿病、糖尿病前期、估计肾小球滤过率<60mL/min/1.73m²、目前怀孕以及去年接受透析的参与者。在中位随访12.3年期间，110名和621名参与者分别经历了心血管死亡和全因死亡。在多变量调整模型中，UACR每增加一倍，心血管死亡风险增加36%[风险比(HR)1.36，95%置信区间(CI)1.02 - 1.82]，全因死亡风险增加24%(HR 1.24，95%CI 1.10 - 1.39)。UACR水平<4.18、4.18至<6.91和≥6.91mg/g的15年调整后心血管死亡累积发生率分别为0.91%、0.99%和2.1%。UACR水平<4.18、4.18至<6.91和≥6.91mg/g的15年调整后全因死亡累积发生率分别为5.1%、6.1%和7.4%。
低水平范围内（UACR<30mg/g）且无主要心血管危险因素的蛋白尿水平升高的成年人，心血管死亡和全因死亡风险升高。风险随蛋白尿水平升高呈线性增加。这强调了所有蛋白尿水平的风险梯度，即使在所谓的正常范围内，也增加了现有证据。
