Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts
Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts
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DOI：
10.1038/ki.2010.536
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发表时间：
2011-06-01
影响因子：
19.6
通讯作者：
Gansevoort, Ron T.
中科院分区：
文献类型：
--
作者：
van der Velde, Marije;Matsushita, Kunihiro;Gansevoort, Ron T.
建议在高危人群中筛查慢性肾脏疾病，但关于估计肾小球滤过率（eGFR）和白蛋白尿与全因和心血管死亡率的独立和联合相关性的数据有限。为了澄清这一点，我们对10个队列进行了一项协作荟萃分析，其中有266，975名患者因慢性肾脏疾病风险增加而被选择，慢性肾脏疾病定义为高血压，糖尿病或心血管疾病史。全因死亡风险与eGFR在60- 105 ml/min/1.73 m2之间无关，但在较低水平时增加。校正蛋白尿和心血管危险因素后，eGFR为60、45和15 ml/min/1.73 m2时的风险比分别为1.03、1.38和3.11，而eGFR为95时的风险比分别为1.03、1.38和3.11。对数白蛋白尿与无阈值的全因死亡率的对数风险呈线性相关。白蛋白/肌酐比值为10、30和300 mg/g时的校正风险比分别为1.08、1.38和2.16，而比值为5。白蛋白尿和eGFR与全因死亡率呈倍数相关，没有相互作用的证据。在心血管死亡率方面也观察到类似的相关性。具有试纸数据的队列中的结果通常与测量白蛋白/肌酐比值的队列中的结果相当。因此，较低的eGFR和较高的白蛋白尿是高危人群中全因死亡率和心血管死亡率的危险因素，彼此独立，也与心血管危险因素无关。Kidney International（2011）79，1341-1352; doi：10.1038/ki.2010.536; 2011年2月9日在线发表
Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105ml/min per 1.73 m(2), but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15ml/min per 1.73 m(2) were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors. Kidney International (2011) 79, 1341-1352; doi:10.1038/ki.2010.536; published online 9 February 2011