Age and association of kidney measures with mortality and end-stage renal disease.
Age and association of kidney measures with mortality and end-stage renal disease.
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DOI：
10.1001/jama.2012.16817
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发表时间：
2012-12-12
影响因子：
120.7
通讯作者：
Coresh, Josef
中科院分区：
文献类型：
--
作者：
Hallan, Stein I.;Matsushita, Kunihiro;Sang, Yingying;Mahmoodi, Bakhtawar K.;Black, Corri;Ishani, Areef;Kleefstra, Nanne;Naimark, David;Roderick, Paul;Tonelli, Marcello;Wetzels, Jack F. M.;Astor, Brad C.;Gansevoort, Ron T.;Levin, Adeera;Wen, Chi-Pang;Coresh, Josef
慢性肾脏疾病(CKD)在老年人中很常见，但整个年龄段的低估计肾小球滤过率(EGFR)和高蛋白尿的风险影响是有争议的。评估年龄对估计的肾小球滤过率和蛋白尿与临床风险的关系的可能影响，检查相对风险和绝对风险。我们在1972-2011年间对来自亚洲、澳大利亚、欧洲和北美/南美洲的33个普通人群或高危人群和13个CKD队列的2,051,244名参与者进行了调查，平均随访时间为5.8年(0-31年)。在调整了性别、种族、心血管疾病、糖尿病、收缩压、血清胆固醇、体重指数和吸烟后，根据EGFR和蛋白尿对死亡率和终末期肾病(ESRD)的风险比(HR)进行了跨年龄组的荟萃分析。使用HR和平均发病率来评估绝对风险。在每个年龄段中，EGFR越低，蛋白尿越高，死亡率(112,325例死亡)和ESRD(8,411例)风险就越高。在一般/高危队列中，EGFR降低的相对死亡风险随着年龄的增长而降低：例如，在18-54岁、55-、65-74岁和75岁以上年龄组中，EGFR 45与80ml/min/1.73m2的调整后的HR值(95%CI)分别为3.50(2.55-4.81)、2.21(2.02-2.41)、1.59(1.42-1.77)和1.35(1.23-1.48)(年龄交互作用的P值为0.05)。相同比较的绝对风险差异在年龄较大时更高(分别为9.0[95%CI，6.0-12.8]、12.2[10.3-14.3]、13.3[9.0-18.6]和27.2[13.5-45.5]每千人年超额死亡)。对于增加的蛋白尿，随着年龄的增加，相对风险的降低不那么明显，而绝对风险的差异在年龄较大的年龄组中更高(按年龄组分别为7.5[95%CI，4.3-11.9]，12.2[7.9-17.6]，22.7[15.3-31.6]和34.3[19.5-52.4]每千人年额外死亡，ACR300 mg/g比10 mg/g)。在慢性肾脏病队列中，调整后的死亡率相对危险度并没有随着年龄的增长而降低。在所有队列中，较低EGFR或较高蛋白尿的ESRD相对风险和绝对风险差异在不同年龄组之间具有可比性。在广泛的人群中，无论年龄大小，低EGFR和高蛋白尿都与死亡率和终末期肾病独立相关。年龄越大，死亡率的相对危险度越低，绝对危险度越高。
Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial. To evaluate possible effect modification (interaction) of age on the association of estimated GFR and albuminuria with clinical risk examining both relative and absolute risk. We investigated 2,051,244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australesia, Europe, and North/South America conducted during 1972–2011 with mean follow-up time of 5.8 years (range 0–31 years). Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholestserol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates. Mortality (112,325 deaths) and ESRD (8,411 events) risk were higher at lower eGFR and higher albuminuria in every age category. In general/high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age: e.g., adjusted HRs (95% CI) at eGFR 45 vs. 80 ml/min/1.73m2 were 3.50 (2.55–4.81), 2.21 (2.02–2.41), 1.59 (1.42–1.77), and 1.35 (1.23–1.48) in age categories 18–54, 55–64, 65–74 and 75+ years, respectively (P-values for age interaction <0.05). Absolute risk differences for the same comparisons were higher at older age (9.0 [95% CI, 6.0–12.8], 12.2 [10.3–14.3], 13.3 [9.0–18.6], and 27.2 [13.5–45.5] excess deaths per 1,000 person-years, respectively). For increased albuminuria, reduction of relative risk with increasing age were less evident, while differences in absolute risk were higher in the older age categories (7.5 [95% CI, 4.3–11.9], 12.2 [7.9–17.6], 22.7 [15.3–31.6], and 34.3 [19.5–52.4] excess deaths per 1,000 person-years, respectively by age category, at ACR 300 mg/g compared to 10 mg/g). In CKD cohorts, adjusted relative hazards of mortality did not decrease with age. In all cohorts, ESRD relative risks and absolute risk differences at lower eGFR or higher albuminuria were comparable across age categories. Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risks differences at older age.
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艾伯塔省肾脏疾病网络的概述。
影响因子：
2.3
作者：
Hemmelgarn BR;Clement F;Manns BJ;Klarenbach S;James MT;Ravani P;Pannu N;Ahmed SB;MacRae J;Scott-Douglas N;Jindal K;Quinn R;Culleton BF;Wiebe N;Krause R;Thorlacius L;Tonelli M
通讯作者：
Tonelli M
影响因子：
13.6
作者：
Hallan, Stein I.;Coresh, Josef;Holmen, Jostein
通讯作者：
Holmen, Jostein
影响因子：
19.6
作者：
通讯作者：
--
影响因子：
39.2
作者：
Clase, Catherine M.;Gao, Peggy;Mann, Johannes F. E.
通讯作者：
Mann, Johannes F. E.
影响因子：
120.7
作者：
Coresh, Josef;Selvin, Elizabeth;Levey, Andrew S.
通讯作者：
Levey, Andrew S.