Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.
Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.
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DOI：
10.1053/j.ajkd.2008.10.044
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发表时间：
2009-04
期刊：
影响因子：
--
通讯作者：
Astor BC
中科院分区：
文献类型：
--
作者：
Bash LD;Erlinger TP;Coresh J;Marsh-Manzi J;Folsom AR;Astor BC
炎症和止血可能增加肾功能下降的风险，但前瞻性研究的数据很少。社区动脉粥样硬化风险（ARIC）研究，一项前瞻性观察队列。我们使用了来自美国4个不同社区的14854名中年人的数据。检查炎症和止血指标。研究了与这些标志物相关的肾功能下降风险。肾小球滤过率（GFR）由血清肌酐计算，采用4变量MDRD研究方程。慢性肾脏疾病（CKD）的定义是：1)估计GFR从基线时的60以上下降到60 mL/min/1.73 m2以下，或2)CKD住院出院或死亡。在基线和3年和9年随访时测定血清肌酐。通过多变量Cox比例风险回归估计CKD与炎症和止血变量水平升高相关的风险比（HR）。1987年至2004年间发生了1787例慢性肾病。在调整了人口统计学、吸烟、血压、糖尿病、血脂、既往心肌梗死、降压使用、酒精使用、标志物测量年份和基线肾功能（使用估计GFR）后，CKD发生的风险随着白细胞计数的增加而增加(HR Q4 vs. Q1=1.30, 95% CI= (1.12-1.50)；P趋势= 0.001)，纤维蛋白原(1.25,(1.09-1.44)；<0.001)，血管性血友病因子（1.46,1.26-1.68）；<0.001)，因子VIIIc (1.39, 1.20-1.60)；< 0.001)。血清白蛋白与CKD风险呈显著负相关（0.63,0.55-0.72）；< 0.001)。没有发现与VIIc因子水平的独立关联。虽然我们缺乏肾脏功能的直接测量，但与病例定义的相关性很强。炎症和止血指标与肾功能下降的风险增加有关。研究结果表明，炎症和止血是CKD的先决途径。
Inflammation and hemostasis may increase the risk of kidney function decline, but data from prospective studies are sparse. The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort. We used data from the 14,854 middle aged adults from 4 different US communities. Markers of inflammation and hemostasis were examined. Risk of kidney function decline associated with these markers was studied. Glomerular filtration rate (GFR) was calculated from serum creatinine using the 4-variable MDRD Study equation. Chronic kidney disease (CKD) was defined as 1) a decline in estimated GFR below 60 mL/min/1.73 m2 from above 60 at baseline, or 2) a hospitalization discharge or death coded for CKD. Serum creatinine was measured at baseline and at the 3 and 9-year follow-up visits. Hazard ratios (HR) of CKD associated with increased levels of inflammatory and hemostatic variables were estimated by multivariate Cox proportional hazards regression. 1,787 cases of CKD developed between 1987 and 2004. After adjusting for demographics, smoking, blood pressure, diabetes, lipids, prior myocardial infarction, antihypertensive use, alcohol use, year of marker measurement, and baseline renal function using estimated GFR, the risk of incident CKD rose with increasing quartiles of white blood cell count (HR Q4 vs. Q1=1.30, 95% CI= (1.12–1.50); P trend = 0.001), fibrinogen (1.25, (1.09–1.44); <0.001), von Willebrand Factor (1.46, (1.26–1.68); <0.001), and factor VIIIc (1.39, (1.20–1.60); <0.001). A strong inverse association was found between serum albumin and risk of CKD (0.63, (0.55–0.72); <0.001). No independent association was found with levels of factor VIIc. Although we lacked a direct measure of kidney function, associations were robust to case definitions. Markers of inflammation and hemostasis are associated with a greater risk of kidney function decline. Findings suggest that inflammation and hemostasis are antecedent pathways for CKD.
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影响因子：
13.2
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