Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality
Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality
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DOI：
10.1016/j.ahj.2008.02.024
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Bakris, George L.
中科院分区：
文献类型：
--
作者：
McCullough, Peter A.;Li, Suying;Bakris, George L.
背景慢性肾病（CKD）被认为是一种独立的心血管疾病（CVD）风险状态，特别是在老年人中，并且通过估计肾小球滤过率（eGFR）水平和肾损伤标志物来定义。中青年CKD与CVD之间的关系尚未得到充分探讨。方法社区志愿者完成对既往医疗事件的调查，并接受血压和实验室检测。慢性肾病定义为 eGFR < 60 mL。分钟(-1) 。 1.73 m(-2) 或尿白蛋白肌酐比值 (ACR) >= 30 mg/g。早发CVD被定义为男性年龄<55岁、女性年龄<65岁的自我报告的心肌梗塞或中风。通过与国家数据系统的连接来确定死亡率。结果 31 417 名参与者的平均年龄为 45.1 +/- 11.2 岁，75.5% 为女性，36.8% 为非洲裔美国人，21.6% 患有糖尿病。总共 20.6% 的人被发现患有 CKD，其中 ACR 和 eGFR 分别是年轻和老年十分位中的主要阳性筛查测试。对于患有和不患有 CKD 的患者，过早心肌梗死 (MI)、卒中或死亡的患病率以及综合患病率分别为 5.3%、4.7%、0.8%、9.2% 和 2.5%、2.2%、0.2%、4.2%（综合 P < 0.0001）。多变量分析发现 CKD（OR 1.44，95% CI 1.27-1.63）、年龄（OR 1.05 [每年]，95% CI 1.04-1.06）、高血压（OR 1.61，95% CI 1.40-1.84）、糖尿病（OR 2.03，95% CI 1.79-2.29）、吸烟（或 1.91，95% CI 1.66-2.21）和高中教育程度以下（OR 1.59，95% CI 1.37-1.85）是过早 CVD 或死亡的最显着相关因素（所有 P < .0001）。生存分析发现，患有过早 MI 或中风和 CKD 的患者在筛查后未来 3 年的短期生存率最差。结论 对于年龄小于 55 岁和 65 岁的男性和女性来说，慢性肾脏病分别是 MI、中风和死亡的独立预测因素。这些数据表明，肾衰竭引起的生物学变化会加速心血管疾病的发生，而传统的危险因素或年龄较大无法完全解释这一点。使用 ACR 和 eGFR 筛查 CKD 可以识别过早 CVD 和近期死亡高风险的年轻和中年个体。
Background Chronic kidney disease (CKD) is recognized as an independent cardiovascular disease (CVD) risk state, particularly in the elderly, and has been defined by levels of estimated glomerular filtration rate (eGFR) and markers of kidney damage. The relationship between CKD and CVD in younger and middle-aged adults has not been fully explored.Methods Community volunteers completed surveys regarding past medical events and underwent blood pressure and laboratory testing. Chronic kidney disease was defined as an eGFR < 60 mL . min(-1) . 1.73 m(-2) or urine albumin-creatinine ratio (ACR) >= 30 mg/g. Premature CVD was defined as self-reported myocardial infarction or stroke at < 55 years of age in men and < 65 years of age in women. Mortality was ascertained by linkage to national data systems.Results Of 31 417 participants, the mean age was 45.1 +/- 11.2 years, 75.5% were female, 36.8% African American, and 21.6% had diabetes. A total of 20.6% were found to have CKD, with the ACR and eGFR being the dominant positive screening tests in the younger and older age deciles, respectively. The prevalences of premature myocardial infarction (MI), stroke, or death, and the composite were 5.3%, 4.7%, 0.8%, 9.2%, and 2.5%, 2.2%, 0.2%, 4.2% for those with and without CKD, respectively (P < .0001 for composite). Multivariable analysis found CKD (OR 1.44, 95% CI 1.27-1.63), age (OR 1.05 [per year], 95% CI 1.04-1.06), hypertension (OR 1.61, 95% CI 1.40-1.84), diabetes (OR 2.03, 95% CI 1.79-2.29), smoking (OR 1.91, 95% CI 1.66-2.21), and less than high school education (OR 1.59, 95% CI 1.37-1.85) as the most significantly associated factors for premature CVD or death (all P < .0001). Survival analysis found those with premature MI or stroke and CKD had the poorest short-term survival over the next 3 years after screening.Conclusions Chronic kidney disease is an independent predictor of MI, stroke, and death among men and women younger than age 55 and 65 years, respectively. These data suggest the biologic changes that occur with kidney failure promote CVD at an accelerated rate that cannot be fully explained by conventional risk factors or older age. Screening for CKD by using both the ACR and eGFR can identify younger and middle-aged individuals at high risk for premature CVD and near-term death.