Zhou Ce, Zhou You, Shuai Niannian, Zhou Jiaxiu, Kuang Xin
Department of Anesthesiology, People's Hospital of Longhua, Shenzhen, China.
The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Front Cardiovasc Med. 2024 Nov 22;11:1417926. doi: 10.3389/fcvm.2024.1417926. eCollection 2024.
Estimated glomerular filtration rate (eGFR) is a key indicator of kidney function and is associated with numerous health conditions. This study examines the association between eGFR and cardiovascular disease (CVD) risk in a representative cohort of the US adult population.
A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. The study included 31,020 participants aged 20 years and older. The eGFR estimates were calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CVD was defined as a self-reported physician's diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, or stroke. To assess the association between eGFR and CVD risk, the study employed weighted linear regression and generalized additive models.
The study revealed a significant non-linear inverse association between eGFR and CVD risk, with a threshold effect observed at 99.3 ml/min/1.73 m². Below this threshold, each 10-unit increase in eGFR was associated with a 13% decrease in the odds of CVD (OR: 0.87, 95% CI: 0.84-0.90, < 0.001). Above this threshold, no significant association was found between eGFR and CVD risk (OR: 1.04, 95% CI: 0.90-1.20, = 0.60), indicating that further increases in eGFR beyond this point were not associated with additional cardiovascular benefits. Subgroup analyses revealed significant interactions for eGFR categories, anemia status, and ratio of family income to poverty (PIR).
This study shows that there is a non-linear relationship between eGFR and CVD risk in the US adult population. The study found evidence of a threshold effect. These findings emphasize the importance of monitoring and managing CVD risk factors in individuals with reduced kidney function, especially those with eGFR values below the identified threshold. The relationship between eGFR and CVD risk varies across different subgroups, particularly in relation to eGFR categories, anemia status, and socioeconomic factors.The results provide valuable insights for developing targeted CVD prevention and treatment strategies based on kidney function status.
估算肾小球滤过率（eGFR）是肾功能的关键指标，与多种健康状况相关。本研究在美国成年人群的代表性队列中，考察eGFR与心血管疾病（CVD）风险之间的关联。
利用2007年至2018年美国国家健康与营养检查调查（NHANES）的数据进行横断面分析。该研究纳入了31,020名20岁及以上的参与者。eGFR估算值采用慢性肾脏病流行病学协作组（CKD-EPI）方程计算。CVD定义为医生自我报告诊断的充血性心力衰竭、冠心病、心绞痛、心肌梗死或中风。为评估eGFR与CVD风险之间的关联，该研究采用加权线性回归和广义相加模型。
该研究揭示了eGFR与CVD风险之间存在显著的非线性负相关，在99.3 ml/min/1.73 m²处观察到阈值效应。低于此阈值，eGFR每增加10个单位，CVD发生几率降低13%（比值比：0.87，95%置信区间：0.84 - 0.90，P < 0.001）。高于此阈值，未发现eGFR与CVD风险之间存在显著关联（比值比：1.04，95%置信区间：0.90 - 1.20，P = 0.60），这表明eGFR超过这一点的进一步升高与额外的心血管益处无关。亚组分析揭示了eGFR类别、贫血状态以及家庭收入与贫困比（PIR）之间存在显著交互作用。
本研究表明，美国成年人群中eGFR与CVD风险之间存在非线性关系。该研究发现了阈值效应的证据。这些发现强调了对肾功能降低的个体，尤其是eGFR值低于确定阈值的个体，监测和管理CVD危险因素的重要性。eGFR与CVD风险之间的关系在不同亚组中有所不同，特别是在eGFR类别、贫血状态和社会经济因素方面。这些结果为基于肾功能状况制定有针对性的CVD预防和治疗策略提供了有价值的见解。
