Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort
Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort
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DOI：
10.1016/s0272-6386(04)00934-5
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发表时间：
2004-10-01
影响因子：
13.2
通讯作者：
Takishita, S
中科院分区：
文献类型：
--
作者：
Iseki, K;Ikemiya, Y;Takishita, S
背景：尿酸可能是肾脏疾病及其进展的真正中介。然而，在基于社区的筛查中，血清尿酸水平对终末期肾病（ESRD）发生风险的重要性的流行病学证据很少。方法：1993年由日本冲绳普通健康维护协会开展的大规模筛查的参与者进行了调查：研究了48,177名20岁以上的筛查者（22,949名男性，25,228名女性）的血清尿酸数据。在冲绳接受治疗的所有透析患者均独立登记在冲绳透析研究登记处。在1993年的筛查中，后来进入透析计划的参与者是通过2个计算机登记来确定的。ESRD的累积发病率根据男女基线血清尿酸水平的四分位数计算。高尿酸血症（男性血清尿酸水平大于等于7.0 mg/dL[大于等于416 mumol/L]，女性血清尿酸水平大于等于6.0 mg/dL[大于等于357 mumol/L]）在调整年龄、血压、体重指数、蛋白尿、红细胞压积、总胆固醇、甘油三酯、空腹血糖和血清肌酐水平后，通过Cox模型评估高尿酸血症对发生ESRD风险的意义。结果：男性平均血尿酸水平为6.4 +/- 1.4 (SD) mg/dL (381 μ mol/L)，女性平均血尿酸水平为4.8 +/- 1.1 mg/dL （286 μ mol/L）。高尿酸血症的患病率男性为31.9%，女性为13.6%。到2000年底，共有103名筛查者（53名男性，50名女性）参加了透析项目。每1000名筛查者中ESRD的计算发生率为：无高尿酸血症男性1.22，高尿酸血症男性4.64，无高尿酸血症女性0.87，高尿酸血症女性9.03。男性高尿酸血症的校正危险比为2.004（95%可信区间，0.904 ~ 4.444,P =无统计学意义），女性高尿酸血症的校正危险比为5.770（95%可信区间，2.309 ~ 14.421,P = 0.0002）。结论：筛选者高尿酸血症与ESRD的发生率较高相关。高尿酸血症（血清尿酸大于或等于6.0 mg/dL[大于或等于357 μ mol/L]）是女性ESRD的独立预测因子。控制血清尿酸水平在正常范围内的策略可以减轻ESRD的人群负担。
Background: Uric acid may be a true mediator of renal disease and progression. However, epidemiological evidence for the significance of serum uric acid levels on the risk for developing end-stage renal disease (ESRD) is scarce in a setting of community-based screening. Methods: Participants in a 1993 mass screening conducted by the Okinawa General Health Maintenance Association in Okinawa, Japan, were investigated: 48,177 screenees (22,949 men, 25,228 women) older than 20 years for whom serum uric acid data were available were studied. All dialysis patients treated in Okinawa were independently registered in the Okinawa Dialysis Study registry. Participants in the 1993 screening who later entered a dialysis program were identified by using 2 computer registries. The cumulative incidence of ESRD was calculated according to quartiles of baseline serum uric acid levels for each sex. The significance of hyperuricemia (serum uric acid level greater than or equal to7.0 mg/dL [greater than or equal to416 mumol/L] in men and greater than or equal to6.0 mg/dL [greater than or equal to357 mumol/L] in women) for the risk for developing ESRD was evaluated by means of the Cox model after adjusting for age, blood pressure, body mass index, proteinuria, hematocrit, and total cholesterol, triglyceride, fasting blood glucose, and serum creatinine levels. Results: Mean serum uric acid level was 6.4 +/- 1.4 (SD) mg/dL (381 mumol/L) in men and 4.8 +/- 1.1 mg/dL (286 mumol/L) in women. Prevalences of hyperuricemia were 31.9% in men and 13.6% in women. By the end of 2000, a total of 103 screenees (53 men, 50 women) entered dialysis programs. Calculated incidences of ESRD per 1,000 screenees were 1.22 for men without hyperuricemia and 4.64 for men with hyperuricemia and 0.87 for women without hyperuricemia and 9.03 for women with hyperuricemia. Adjusted hazard ratios for hyperuricemia were 2.004 (95% confidence interval, 0.904 to 4.444; P = not significant) in men and 5.770 (95% confidence interval, 2.309 to 14.421; P = 0.0002) in women. Conclusion: Screenees with hyperuricemia were associated with a greater incidence of ESRD. Hyperuricemia (serum uric acid greater than or equal to 6.0 mg/dL [greater than or equal to357 mumol/L]) was an independent predictor of ESRD in women. Strategies to control serum uric acid levels in the normal range may reduce the population burden of ESRD.