White blood cell count predicts the odds of kidney function decline in a Chinese community-based population.
White blood cell count predicts the odds of kidney function decline in a Chinese community-based population.
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DOI：
10.1186/s12882-017-0608-4
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发表时间：
2017-06-07
期刊：
影响因子：
2.3
通讯作者：
Zhang Y
中科院分区：
文献类型：
--
作者：
Fan F;Jia J;Li J;Huo Y;Zhang Y
炎症过程在肾脏疾病的发展中非常重要。然而，白色血细胞（WBC）计数与肾功能不全风险之间的相关性尚未得到充分确立，尤其是在无慢性肾脏疾病（CKD）的受试者中。我们的研究调查了基线估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m2的中国社区人群中WBC计数与肾功能下降之间的相关性。本研究共纳入3768例北京地区动脉粥样硬化队列研究受试者。在基线和随访时使用CKD-EPI公式计算EGFR。本研究的结局为肾功能下降（RFD）（eGFR分期沿着下降，eGFR下降25%或超过5 mL/min/1.73 m2/年）、eGFR快速下降（eGFR每年下降超过3 mL/min/1.73 m2）和CKD事件（随访时eGFR <60 min/1.73 m2）。采用多变量logistic回归模型评估WBC计数与各结局之间的相关性。受试者平均年龄为56.6 ± 8.5岁，35.9%为男性。在参与者中，48.6%患有高血压，17.4%患有糖尿病。基线时平均（SD）WBC计数为6.1 ± 1.5 × 109/L。基线时平均（SD）eGFR为101.1 ± 10.6 mL/min/1.73 m2。2.3年随访后，RFD、eGFR快速下降和新发CKD的发生率分别为7.7%、20.9%和0.8%。在单变量分析中，WBC计数与RFD、eGFR快速下降和新发CKD显著相关。即使在调整人口统计学变量、合并症、药物和基线eGFR后，这些相关性仍然存在。此外，在按每个混杂变量分层的几乎所有亚组中观察到RFD的相似趋势。在未接受降脂药物治疗的受试者中，与WBC计数每增加109/L相关的RFD几率增加显著大于未接受该治疗的受试者（P-相互作用：0.05）。总之，白细胞计数升高可作为该人群肾功能下降几率的预测因子，这支持全身性炎症可能是CKD发展的风险因素的假设。本文的在线版本（doi：10.1186/s12882-017-0608-4）包含补充材料，可供授权用户使用。
Inflammatory processes are very important in the development of kidney disease. Nevertheless, the association between white blood cell (WBC) count and the risk of renal dysfunction has not been well-established, especially in subjects without chronic kidney disease (CKD). Our study investigated the association between WBC count and kidney function decline in a Chinese community-based population with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2. A total of 3768 subjects who were enrolled in an atherosclerosis cohort in Beijing were included in this study. EGFRs were calculated at baseline and follow-up using the CKD-EPI formula. The outcomes of this study were renal function decline (RFD) (a drop in eGFR stage along with a decline in eGFR of 25% or exceeding 5 mL/min/1.73 m2/year), rapid eGFR decline (an annual decrease in eGFR exceeding 3 mL/min/1.73 m2), and incident CKD (eGFR <60 min/1.73 m2 at follow-up). Multivariate logistic regression models were used to evaluate the associations between WBC count and each outcome. On average, the subjects were 56.6 ± 8.5 years old, and 35.9% were male. Of the participants, 48.6% had hypertension and 17.4% had diabetes. The mean (SD) WBC count at baseline was 6.1 ± 1.5 × 109/L. The mean (SD) eGFR at baseline was 101.1 ± 10.6 mL/min/1.73 m2. After 2.3 years follow-up, the incidence rates of RFD, rapid eGFR decline and new CKD were 7.7, 20.9, and 0.8%, respectively. WBC count was significantly related to RFD, rapid eGFR decline and new CKD in the univariate analyses. Even after adjustment for demographic variables, comorbidities, medications and baseline eGFR, these associations remained. Moreover, similar trends in RFD were observed in nearly all subgroups stratified by each confounding variable. The increase in the odds of RFD associated with each 109/L increase in WBC count was significantly greater in subjects not undergoing treatment with lipid-lowering drugs than those not undergoing this treatment (P-interaction: 0.05). In conclusion, elevated WBC count served as a predictor of the odds of kidney function decline in this population, which supports the hypothesis that systemic inflammation may serve as a risk factor for CKD development. The online version of this article (doi:10.1186/s12882-017-0608-4) contains supplementary material, which is available to authorized users.