Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
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DOI：
10.1016/s0140-6736(10)60674-5
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发表时间：
2010-06-12
期刊：
影响因子：
168.9
通讯作者：
Gansevoort, Ron T.
中科院分区：
文献类型：
--
作者：
Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
评估肾功能对普通人群风险的影响需要全面评估估计肾小球滤过率（eGFR）和蛋白尿与死亡率的独立及联合关联，这对改进慢性肾脏病（CKD）的定义和分期具有重要意义。
对普通人群队列进行了一项协作荟萃分析，以汇集全因死亡率和心血管死亡率的标准化数据。对14项研究（105872名参与者；730577人年）中尿白蛋白 - 肌酐比（ACR）测量值以及7项研究（1128310名参与者；4732110人年）中尿蛋白试纸测量值的两项肾脏指标和潜在混杂因素进行了建模。
在ACR研究中，在75 - 105 ml/min/1·73 m²之间，死亡率风险与eGFR无关，在eGFR较低时风险增加。eGFR为60、45和15（相对于95）ml/min/1·73 m²时全因死亡率的校正风险比（HRs）分别为1·18（95%置信区间：1·05 - 1·32）、1·57（1·39 - 1·78）和3·14（2·39 - 4·13）。ACR在对数 - 对数尺度上与死亡率风险呈线性相关，无阈值效应。ACR为10、30和300（相对于5）mg/g时全因死亡率的校正HRs分别为1·20（1·15 - 1·26）、1·63（1·50 - 1·77）和2·22（1·97 - 2·51）。eGFR和ACR与死亡率呈相乘关系，无交互作用的证据。在心血管死亡率和试纸研究中也观察到了类似的结果。
较低的eGFR（<60 ml/min/1·73 m²）和较高的蛋白尿（ACR≥10 mg/g）是普通人群中死亡率风险的独立预测因素。本研究为使用这两项肾脏指标进行风险评估以及CKD的定义和分期提供了定量数据。
A comprehensive evaluation of the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality is required for assessment of the impact of kidney function on risk in the general population, with implications for improving the definition and staging of chronic kidney disease (CKD). A collaborative meta-analysis of general population cohorts was undertaken to pool standardized data for all-cause and cardiovascular mortality. The two kidney measures and potential confounders from 14 studies (105,872 participants; 730,577 person-years) with urine albumin-to-creatinine ratio (ACR) measurements and seven studies (1,128,310 participants; 4,732,110 person-years) with urine protein dipstick measurements were modeled. In ACR studies, mortality risk was unrelated to eGFR between 75-105 ml/min/1·73 m2 and increased at lower eGFR. Adjusted hazard ratios (HRs) for all-cause mortality at eGFR 60, 45, and 15 (versus 95) ml/min/1·73 m2 were 1·18 (95% CI: 1·05-1·32), 1·57 (1·39-1·78), and 3·14 (2·39-4·13), respectively. ACR was associated with mortality risk linearly on the log-log scale without threshold effects. Adjusted HRs for all-cause mortality at ACR 10, 30, and 300 (versus 5) mg/g were 1·20 (1·15-1·26), 1·63 (1·50-1·77), and 2·22 (1·97-2·51). eGFR and ACR were multiplicatively associated with mortality without evidence of interaction. Similar findings were observed for cardiovascular mortality and in dipstick studies. Lower eGFR (<60 ml/min/1·73 m2) and higher albuminuria (ACR ≥10 mg/g) were independent predictors of mortality risk in the general population. This study provides quantitative data for using both kidney measures for risk evaluation and CKD definition and staging.