Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data.
Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data.
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DOI：
10.1016/s2213-8587(15)00040-6
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
CKD Prognosis Consortium
中科院分区：
文献类型：
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作者：
Matsushita K;Coresh J;Sang Y;Chalmers J;Fox C;Guallar E;Jafar T;Jassal SK;Landman GW;Muntner P;Roderick P;Sairenchi T;Schöttker B;Shankar A;Shlipak M;Tonelli M;Townend J;van Zuilen A;Yamagishi K;Yamashita K;Gansevoort R;Sarnak M;Warnock DG;Woodward M;Ärnlöv J;CKD Prognosis Consortium
估计肾小球滤过率（eGFR）和白蛋白尿对心血管疾病预测的效用是有争议的。我们荟萃分析了24个队列的个体水平数据（中位随访时间超过4年，从4.2年到19.0年不等）（637，315例无心血管疾病史的受试者），并评估了心血管死亡率以及冠心病致死性和非致死性病例的C统计量差异和重新分类改善，中风和心力衰竭的5年时间范围内，对比预测模型，包括传统的风险因素，有和没有肌酐为基础的eGFR和/或白蛋白尿（白蛋白与肌酐比值[ACR]或半定量试纸蛋白尿）。增加eGFR和ACR显着改善了一般人群中传统风险因素以外的心血管结局的区分度，但ACR的改善效果比eGFR更大，并且对心血管死亡率的改善效果更明显（c-统计学差异0.0139 [95%CI 0.0105-0.0174]和0.0065 [0.0042-0.0088]，分别）和心力衰竭（0.0196 [0.0108-0.0284]和0.0109 [0.0059-0.0159]）（0.0048 [0.0029-0.0067]和0.0036 [0.0019-0.0054]）和中风（0.0105 [0.0058-0.0151]和0.0036 [0.0004-0.0069]）。试纸蛋白尿的改善程度小于ACR。肾脏测量的辨别力改善在糖尿病或高血压患者中尤其明显，但在没有这两种疾病的患者中，ACR对心血管死亡率和心力衰竭的影响仍然显著。在慢性肾脏病（CKD）受试者中，eGFR和ACR联合用于风险区分优于大多数单一传统预测因子;当忽略eGFR和ACR与任何单一可修改的传统预测因子相比时，心血管死亡率的c统计量分别下降0.023 [0.016-0.030] vs. <0.007。心血管预测应考虑基于肌酐的eGFR和白蛋白尿，特别是当它们已经被评估用于临床目的和/或心血管死亡率和心力衰竭是感兴趣的结果时（例如，欧洲心血管疾病预防指南）。ACR可能对心血管预测具有特别广泛的影响。在CKD人群中，同时评估eGFR和ACR将有助于改善心血管风险分类，支持当前的CKD指南。美国国家肾脏基金会和NIDDK
The utility of estimated glomerular filtration rate (eGFR) and albuminuria for cardiovascular prediction is controversial. We meta-analyzed individual-level data from 24 cohorts (with a median follow-up time longer than 4 years, varying from 4.2 to 19.0 years) in the Chronic Kidney Disease Prognosis Consortium (637,315 participants without a history of cardiovascular disease) and assessed C-statistic difference and reclassification improvement for cardiovascular mortality and fatal and non-fatal cases of coronary heart disease, stroke, and heart failure in 5-year timeframe, contrasting prediction models consisting of traditional risk factors with and without creatinine-based eGFR and/or albuminuria (either albumin-to-creatinine ratio [ACR] or semi-quantitative dipstick proteinuria). The addition of eGFR and ACR significantly improved the discrimination of cardiovascular outcomes beyond traditional risk factors in general populations, but the improvement was greater with ACR than with eGFR and more evident for cardiovascular mortality (c-statistic difference 0.0139 [95%CI 0.0105–0.0174] and 0.0065 [0.0042–0.0088], respectively) and heart failure (0.0196 [0.0108–0.0284] and 0.0109 [0.0059–0.0159]) than for coronary disease (0.0048 [0.0029–0.0067] and 0.0036 [0.0019–0.0054]) and stroke (0.0105 [0.0058–0.0151] and 0.0036 [0.0004–0.0069]). Dipstick proteinuria demonstrated smaller improvement than ACR. The discrimination improvement with kidney measures was especially evident in individuals with diabetes or hypertension but remained significant with ACR for cardiovascular mortality and heart failure in those without either of these conditions. In participants with chronic kidney disease (CKD), the combination of eGFR and ACR for risk discrimination outperformed most single traditional predictors; the c-statistic for cardiovascular mortality declined by 0.023 [0.016–0.030] vs. <0.007 when omitting eGFR and ACR vs. any single modifiable traditional predictors, respectively. Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when they are already assessed for clinical purpose and/or cardiovascular mortality and heart failure are the outcomes of interest (e.g., the European guidelines on cardiovascular prevention). ACR may have particularly broad implications for cardiovascular prediction. In CKD populations, the simultaneous assessment of eGFR and ACR will facilitate improved cardiovascular risk classification, supporting current CKD guidelines. US National Kidney Foundation and NIDDK