Urinary Tubular Injury Biomarkers Are Associated With ESRD and Death in the REGARDS Study
Urinary Tubular Injury Biomarkers Are Associated With ESRD and Death in the REGARDS Study
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DOI：
10.1016/j.ekir.2018.05.013
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发表时间：
2018-09-01
影响因子：
6
通讯作者：
Peralta, Carmen A.
中科院分区：
文献类型：
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作者：
Dubin, Ruth F.;Judd, Suzanne;Peralta, Carmen A.
简介：尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和尿肾损伤分子-1（uKIM-1）是亚临床急性肾损伤的既定标志物。在肾小球滤过率（eGFR）和蛋白尿估计值降低的患者中，终末期肾病（ESRD）和死亡的风险较高，这些尿液标志物与ESRD事件或死亡的相关性是一个积极研究的领域。在1472名eGFR = 30 mg/g的卒中地理和种族差异原因（REGARDS）研究的黑人和白色参与者中，我们评估了基线uNGAL和uKIM-1与进展为ESRD和全因死亡的相关性。考克斯模型依次调整尿肌酐，传统的危险因素，C-反应蛋白，ACR，和eGFR.Results：有257终末期肾病事件和819例死亡，中位随访时间分别为5.7年和6.5年。在人口统计学校正模型中，较高水平的uNGAL与ESRD和死亡风险增加相关，但在包括基线eGFR的完全校正模型中，这些相关性减弱，包括ESRD（风险比[HR] = 1.06/加倍，95%置信区间[CI] 0.98-1.14）和死亡（HR = 1.04，95% CI = 1.00-1.08）。在人口统计学校正模型中，较高水平的uKIM-1与ESRD和死亡风险增加相关，尽管在完全校正模型中有所减弱，但对于两种ESRD，（HR = 1.24/加倍，95%CI = 1.08-1.42）和死亡（HR = 1.10，95%CI =1.03-1.19）。
Introduction: Urinary neutrophil gelatinase associated lipocalin (uNGAL) and urinary kidney injury molecule-1 (uKIM-1) are established markers of subclinical acute kidney injury. In persons with reduced estimated glomerular filtration rate (eGFR) and albuminuria who are at high risk for end-stage renal disease (ESRD) and death, the associations of these urinary markers with incident ESRD or death is an area of active investigation.Methods: Among 1472 black and white participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study with eGFR = 30 mg/g, we evaluated the associations of baseline uNGAL and uKIM-1 with progression to ESRD and all-cause death. Cox models were sequentially adjusted for urinary creatinine, traditional risk factors, C-reactive protein, ACR, and eGFR.Results: There were 257 ESRD events and 819 deaths over a median follow-up of 5.7 and 6.5 years, respectively. In demographic adjusted models, higher levels of uNGAL were associated with increased risk of ESRD and death, but these associations were attenuated in fully adjusted models including baseline eGFR for both ESRD (hazard ratio [HR] = 1.06 per doubling, 95% confidence interval [CI] 0.98-1.14) and death (HR = 1.04, 95% CI = 1.00-1.08). Higher levels of uKIM-1 were associated with increased risk of ESRD and death in demographic-adjusted models, and although attenuated in fully adjusted models, remained statistically significant for both ESRD (HR = 1.24 per doubling, 95% CI = 1.08-1.42) and death (HR = 1.10, 95% CI =1.03-1.19).Conclusion: In this cohort of high-risk patients with baseline eGFR