Association of Serum Triglycerides and Renal Outcomes among 1.6 Million US Veterans.
Association of Serum Triglycerides and Renal Outcomes among 1.6 Million US Veterans.
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作者：
Soohoo, Melissa;Hashemi, Leila;Hsiung, Jui-Ting;Moradi, Hamid;Budoff, Matthew J.;Kovesdy, Csaba P.;Kalantar-Zadeh, Kamyar;Streja, Elani
关键词：
以前的研究表明，代谢综合征(METS)的成分与肾脏结局有关，肾脏结局的定义是肾功能下降或达到终末期肾病(ESRD)。甘油三酯升高(TGS)是蛋氨酸的一种成分，据报道与肾脏预后有关。然而，在慢性肾脏疾病(CKD)患者中，TGS与肾脏结局的相关性独立于METS的其他成分仍未得到充分研究。我们在2004-2006年间检查了1,657,387名具有TGS和METS其他组成部分数据的患者，并进行了跟踪调查，直到2014年。排除接受肾脏替代治疗的终末期肾病患者。我们检测了基线正常肾功能(非CKD)患者的ESRD时间、估计的肾小球滤过率(EGFR)斜率(肾功能下降)和发生CKD的时间(EGFR和lt；60mL/min/1.73m<sup>2</sup>)，使用COX或Logistic回归分析，调整了临床特征和蛋氨酸成分。我们还根据蛋氨酸成分的数量对分析进行了分层。队列的平均年龄为，其中5%为女性，15%为非裔美国人，24%为非透析依赖型慢性肾脏病。在非CKD患者中，TGS与发生CKD的时间之间的调整关系很强且呈线性。与TGS 120 mg/dL和160 mg/dL相比，在所有CKD分期中，较高的TGS与较快的肾功能下降有关。TGS240 mg/dL升高与非慢性肾脏病和慢性肾脏病3A-3B期患者发生终末期肾病的时间相关，而在慢性肾脏病4-5期，风险逐渐下降至零或更低。模型经蛋氨酸成分调整和分层后是稳健的。与蛋氨酸成分无关，高TGS水平与更高的CKD发生率和更快的肾功能下降有关，但与CKD 4-5期的ESRD时间无关或呈负相关。检测降低TGS干预对CKD发病和肾脏保护治疗的影响值得进一步研究，包括临床试验。
Previous studies have suggested that metabolic syndrome (MetS) components are associated with renal outcomes, defined as a decline in kidney function or reaching end-stage renal disease (ESRD). Elevated triglycerides (TGs) are a component of MetS that have been reported to be associated with renal outcomes. However, the association of TGs with renal outcomes in chronic kidney disease (CKD) patients independent of the other components of the MetS remains understudied. We examined 1,657,387 patients with data on TGs and other components of MetS in 2004–2006 and followed up until 2014. Patients with ESRD on renal replacement therapy were excluded. We examined time to ESRD, estimated glomerular filtration rate (eGFR) slope (renal function decline), and time to incident CKD (eGFR <60 mL/min/1.73 m<sup>2</sup>) among baseline normal kidney function (non-CKD) patients, using Cox or logistic regression, adjusted for clinical characteristics and MetS components. We also stratified analyses by the number of MetS components. The cohort was on average 64 years old and comprised 5% females, 15% African Americans, and 24% with nondialysis-dependent CKD. Among non-CKD patients, the adjusted relationship of TGs with time to incident CKD was strong and linear. Compared to TGs 120–<160 mg/dL, higher TGs were associated with a faster renal function decline across all CKD stages. Elevated TGs ≥240 mg/dL were associated with a faster time to ESRD among non-CKD and CKD stages 3A–3B, while the risk gradually declined to null or lower in CKD stages 4–5. Models were robust after MetS component adjustment and stratification. Independent of MetS components, high TGs levels were associated with a higher incidence of CKD and a faster renal function decline, yet showed no or inverse associations with time to ESRD in CKD stages 4–5. Examining the effects of TGs-lowering interventions on incident CKD and kidney preserving therapy warrants further studies including clinical trials.
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DOI：
10.2215/cjn.10441013
发表时间：
2014-10-01
影响因子：
9.8
作者：
Hoogeveen, Ellen K.;Geleijnse, Johanna M.;Giltay, Erik J.
通讯作者：
Giltay, Erik J.
影响因子：
1.6
作者：
De Cosmo S;Viazzi F;Pacilli A;Giorda C;Ceriello A;Gentile S;Russo G;Rossi MC;Nicolucci A;Guida P;Pontremoli R;and the AMD-Annals Study Group
通讯作者：
and the AMD-Annals Study Group
影响因子：
8.3
作者：
Nilsson, Peter M.;Tuomilehto, Jaakko;Ryden, Lars
通讯作者：
Ryden, Lars
影响因子：
16.2
作者：
Forsblom C;Hiukka A;Leinonen ES;Sundvall J;Groop PH;Taskinen MR
通讯作者：
Taskinen MR
DOI：
10.2215/cjn.09870912
发表时间：
2013-06-01
影响因子：
9.8
作者：
Navaneethan, Sankar D.;Schold, Jesse D.;Nally, Joseph V., Jr.
通讯作者：
Nally, Joseph V., Jr.