Jagannathan Ram, Anand Shuchi, Kondal Dimple, Han Jialin, Montez-Rath Maria, Ali Mohammed K, Patel Shivani A, Singh Kavita, Shivashankar Roopa, Anjana R M, Gupta Ruby, Mohan Sailesh, Chertow Glenn M, Mohan Viswanathan, Tandon Nikhil, Venkat Narayan K M, Prabhakaran Dorairaj
Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA.
CoE-CARRS, Public Health Foundation of India, New Delhi, India.
Kidney Int Rep. 2024 May 29;9(8):2537-2545. doi: 10.1016/j.ekir.2024.05.025. eCollection 2024 Aug.
Associations between markers of impaired kidney function and adverse outcomes among South Asians is understudied and could differ from existing data derived mostly from North American or European cohorts.
We conducted a prospective analysis of 9797 participants from the ongoing cardiometabolic risk reduction study in South Asia, India. We examined the associations between baseline spot urine albumin-to-creatinine (UACR) ratio and creatinine-based estimated glomerular filtration rate (eGFR) estimating equations with all-cause mortality using Cox proportional hazards regression, adjusting for baseline age, sex, diabetes, systolic blood pressure, tobacco, history of cardiovascular disease, and cholesterol. Additionally, we calculated population attributable fraction (PAF) for both markers.
Over a median 7-year follow-up, with 66,909 person-years, 791 deaths occurred. At baseline, the weighted prevalence of UACR ≥ 30 mg/g and eGFR <60 ml/min per 1.73 m was 6.6% and 1.6%, respectively. The risk for mortality was increased with higher UACR (10-30 hazard ratio [HR]: 1.6 [1.2-2.1]), 30-300 HR: 2.4 [1.8-3.1]), and ≥300 (HR: 6.0 [3.8-9.4] relative to UACR <10 mg/g). Risk for mortality was also higher with lower eGFR (44-30; HR: 4.5 [2.5-8.3] and <30 HR: 7.0 [3.7-13.0], relative to 90-104 ml/min per 1.73 m). PAF for mortality because of UACR ≥30 mg/g and eGFR <45 ml/min per 1.73 m were 24.4% and 13.4%, respectively.
Single-time point assessment of UACR ≥30 mg/g or eGFR <45 ml/min per 1.73 m portends higher mortality risk among urban South Asians. Because albuminuria is common and associated with accelerated decline in GFR, screening and targeted efforts to reduce albuminuria are warranted.
南亚人群中肾功能受损标志物与不良结局之间的关联研究较少，可能与主要来自北美或欧洲队列的现有数据有所不同。
我们对来自印度南亚正在进行的心血管代谢风险降低研究的9797名参与者进行了前瞻性分析。我们使用Cox比例风险回归分析了基线随机尿白蛋白与肌酐比值（UACR）和基于肌酐的估计肾小球滤过率（eGFR）估算方程与全因死亡率之间的关联，并对基线年龄、性别、糖尿病、收缩压、吸烟、心血管疾病史和胆固醇进行了调整。此外，我们计算了这两种标志物的人群归因分数（PAF）。
在中位7年的随访期内，共66909人年，发生了791例死亡。基线时，UACR≥30mg/g和eGFR<60ml/min/1.73m²的加权患病率分别为6.6%和1.6%。UACR升高时死亡风险增加（10 - 30风险比[HR]：1.6[1.2 - 2.1]），30 - 300 HR：2.4[1.8 - 3.1]），≥300（HR：6.0[3.8 - 9.4]，相对于UACR<10mg/g）。eGFR降低时死亡风险也更高（44 - 30；HR：4.5[2.5 - 8.3]，<30 HR：7.0[3.7 - 13.0]，相对于90 - 104ml/min/1.73m²）。UACR≥30mg/g和eGFR<45ml/min/1.73m²导致死亡的PAF分别为24.4%和13.4%。
单次评估UACR≥30mg/g或eGFR<45ml/min/1.73m²预示着城市南亚人群的死亡风险更高。由于蛋白尿常见且与GFR加速下降相关，因此有必要进行筛查并针对性地努力降低蛋白尿。
