The association of urine osmolality with decreased kidney function and/or albuminuria in the United States.
The association of urine osmolality with decreased kidney function and/or albuminuria in the United States.
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在美国，尿液渗透压与肾功能和/或蛋白尿的降低。
DOI：
10.1186/s12882-021-02478-9
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发表时间：
2021-09-10
期刊：
影响因子：
2.3
通讯作者：
Juraschek SP
中科院分区：
文献类型：
--
作者：
Kitiwan BK;Vasunilashorn SM;Baer HJ;Mukamal K;Juraschek SP
肾功能下降通常是由低血容量引起的。低血容量时，肾脏会重新吸收水分，导致尿液浓缩。渗透压是一种测量尿液浓度的方法，比自我报告的液体摄入量更客观。它与低血容量呈正相关。然而，渗透压是否与肾功能下降和/或蛋白尿有关仍然存在争议。我们对2009-2012年全国健康和营养调查进行了横断面分析，这是一项针对美国人口的标准化调查。参与者年龄在18-70岁，尿液渗透压随机。渗透压被分类为四分位数。肾小球滤过率(eGFR) < 60 mL/min/1.73m2定义肾功能下降，白蛋白与肌酐比值≥30 mg/gm定义蛋白尿。我们通过四个顺序模型进行了多变量回归。我们的研究样本包括7373名参与者。平均年龄42.9±0.4岁。总体而言，51.4%为男性，67.3%为白人。eGFR降低和/或蛋白尿患者的平均渗透压分别为603.8 mOsm/kg和629.1 mOsm/kg。病例数为610例（6.7%）。渗透压最低至最高四分位数的患病率分别为116（6.2%）、213（8.6%）、179（7.5%）和102(4.3%)（趋势p值= 0.02）。渗透压与eGFR之间呈非线性关系。在调整了人口统计学、社会、心血管和饮食危险因素后，渗透压四分位数与eGFR和/或蛋白尿降低没有显著关联（优势比[or] 0.77, 95%可信区间[CI] 0.56, 1.07）。在敏感性分析中，渗透压≥500 mOsm/kg与较低的eGFR相关（调整后的ß -1.13, 95% CI -1.98, -0.28）。在预先指定的亚组分析中，渗透压与eGFR在eGFR≥60 mL/min/1.73m2的个体中呈统计学显著负相关，而在eGFR < 60 mL/min/1.73m2的个体中呈正相关（校正ß -0.19, 95% CI -0.36, -0.01与校正ß 0.50, 95% CI 0.05, 0.96；相互作用的p值= 0.016）。在eGFR≥60 mL/min/1.73m2的成年人中，较高的渗透压与较低的eGFR显著相关，未来的研究应在eGFR正常的成年人中检验渗透压与肾功能随时间变化之间的关系。在线版本包含补充材料，可在10.1186/s12882-021-02478-9获得。
Decreased kidney function is commonly caused by hypovolemia. When hypovolemic, the kidney reabsorbs water resulting in concentrated urine. Osmolality is a measure of urine concentration which is more objective than self-reported fluid intake. It has a positive association with hypovolemia. However, it remains controversial whether osmolality is associated with decreased kidney function and/or albuminuria. We conducted a cross-sectional analysis of the 2009–2012 National Health and Nutrition Examination Survey, a standardized survey in the U.S. population. Participants aged 18–70 years old with random urine osmolality were included. Osmolality was categorized as quartiles. Decreased kidney function was defined by estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 and albuminuria was defined by albumin-to-creatinine ratio ≥ 30 mg/gm. We performed multivariable regression via four sequential models. Our study sample included 7,373 participants. The mean age was 42.9 ± 0.4 years. Overall, 51.4% were male and 67.3% were white. The mean osmolality was 603.8 mOsm/kg and 629.1 mOsm/kg in those with and without decreased eGFR and/or albuminuria, respectively. The number of cases was 610 (6.7%). The prevalence from the lowest to highest quartiles of osmolality was 116 (6.2%), 213 (8.6%), 179 (7.5%), and 102 (4.3%), respectively (p-value for trend = 0.02). The relationship between osmolality and eGFR appeared nonlinear. After adjustment for demographic, social, cardiovascular, and dietary risk factors, there was no significant association of osmolality quartiles with decreased eGFR and/or albuminuria (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.56, 1.07). In sensitivity analyses, osmolality ≥ 500 mOsm/kg was associated with lower eGFR (adjusted ß -1.13, 95% CI -1.98, -0.28). In pre-specified subgroup analyses, osmolality had a statistically significant negative correlation with eGFR among individuals with eGFR ≥ 60 mL/min/1.73m2, but a positive correlation among those with eGFR < 60 mL/min/1.73m2 (adjusted ß -0.19, 95% CI -0.36, -0.01 versus adjusted ß 0.50, 95% CI 0.05, 0.96; p-value for interaction = 0.016). Higher osmolality was significantly associated with lower eGFR among adults with eGFR ≥ 60 mL/min/1.73m2 Future research should examine the relationship between osmolality and change in kidney function over time among adults with normal eGFR. The online version contains supplementary material available at 10.1186/s12882-021-02478-9.
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13.2
作者：
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