Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening
Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening
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DOI：
10.1681/asn.2005121352
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发表时间：
2006-09-01
影响因子：
13.6
通讯作者：
Gansevoort, Ronald T.
中科院分区：
文献类型：
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作者：
Halbesma, Nynke;Kuiken, Dirk-Sjoerd;Gansevoort, Ronald T.
在已知患有肾脏疾病的患者中，大量白蛋白尿、血尿和肾功能受损是肾脏不良结局的有力预测因素。然而，在西方人群中，对这些变量进行大规模筛查以识别有肾小球滤过率（GFR）下降风险的个体的效果尚不清楚。利用预防肾脏和血管终末期疾病（PREVEND）研究的数据，这是一项前瞻性、基于人群的队列研究，对具有典型肾脏风险标志物的患者的心血管和肾脏预后进行了研究：大量白蛋白尿（≥300 mg白蛋白/24 h尿液）、血尿（≥250个红细胞/L，无白细胞尿）以及肾功能受损（24小时肌酐清除率和肾病饮食改良公式计算的清除率均低于年龄和性别匹配的对照受试者的第5百分位数）。纳入本研究的8592名患者随访了4年。我们确定了134名大量白蛋白尿患者、128名血尿患者和103名肾功能受损患者。这三组之间只有少量重叠。计算得出大量白蛋白尿、血尿和肾功能受损在一般人群中的患病率分别为0.6%、1.3%和0.9%。在所有三组中，在筛查前已知有这种实验室异常的患者不到30%。大量白蛋白尿组心血管疾病的发病率较高（例如，心血管疾病导致死亡的年龄和性别调整后的风险比为2.6[1.1 - 6.0]），肾功能受损组也是如此（3.4[1.5 - 8.0]）。平均随访4.2年后，大量白蛋白尿组估计的GFR（eGFR）下降为 -7.2 ml/min每1.73 m²，而对照组为 -2.3 ml/min每1.73 m²（差异P < 0.001），然而肾功能受损组（-0.2 ml/min每1.73 m²；P = 0.18）和血尿组（-2.6 ml/min每1.73 m²）的eGFR下降率与对照组无差异。大量白蛋白尿和肾功能受损都预示着心血管发病率和死亡率方面的预后更差。然而，在人群筛查中识别有加速GFR下降风险的个体时，大量白蛋白尿是比低eGFR或血尿更好的风险标志物。
Macroalbuminuria, erythrocyturia, and impaired renal function are strong predictors of poor renal outcome in patients with known renal disease. However, the yield of mass screening for these variables to identify individuals who are at risk for GFR loss is yet unknown in a Western population. With the use of data from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort study, the cardiovascular and renal prognosis was investigated in patients with classical renal risk markers: Macroalbuminuria (>= 300 mg albumin/24 h urine), erythrocyturia (>= 250 erythrocytes/L, without leukocyturia), and impaired renal function (both 24-h creatinine clearance and Modification of Diet in Renal Disease clearance below the fifth percentile of age- and gender-matched control subjects). The 8592 patients who were included in this study were followed for a 4-yr period. We identified 134 patients with macroalbuminuria, 128 with erythrocyturia, and 103 with impaired renal function. There was only a little overlap among the three groups. The prevalence of macroalbuminuria, erythrocyturia, and impaired renal function was calculated to be in the general population 0.6, 1.3, and 0.9%, respectively. In all three groups, fewer than 30% of patients were known to have this laboratory abnormality before screening. The incidence of cardiovascular disease was high in the macroalbuminuria group (e.g., the age- and gender-adjusted hazard ratio for mortality as a result of cardiovascular disease is 2.6 [1.1 to 6.0]) and for the impaired renal function group (3.4 [1.5 to 8.0]). After a mean follow-up of 4.2 yr, the macroalbuminuria group showed a -7.2 ml/min per 1.73 m(2) estimated GFR (eGFR) loss, compared with -2.3 ml/min per 1.73 m(2) in the control group (difference P < 0.001), whereas the rate of eGFR loss in the impaired renal function group (-0.2 ml/min per 1.73 m(2); P = 0.18) and the erythrocyturia group (-2.6 ml/min per 1.73 m(2)) was not different from the control group. Macroalbuminuria and impaired renal function both predict a worse prognosis with respect to cardiovascular morbidity and mortality. However, macroalbuminuria is a better risk marker than low eGFR or erythrocyturia to identify in population screening of individuals who are at risk for accelerated GFR loss.