A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury.
A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury.
复制标题
DOI：
10.1053/j.ajkd.2015.02.338
复制
发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
CKD Prognosis Consortium
中科院分区：
文献类型：
--
作者：
James MT;Grams ME;Woodward M;Elley CR;Green JA;Wheeler DC;de Jong P;Gansevoort RT;Levey AS;Warnock DG;Sarnak MJ;CKD Prognosis Consortium
糖尿病和高血压是急性肾损伤(AKI)的危险因素。在存在和不存在这些条件的情况下，估计的肾小球滤过率(EGFR)和尿白蛋白肌酐比(ACR)是否仍是AKI的危险因素尚不确定。队列研究的荟萃分析。8个普通人群(1,285,045名参与者)和5个CKD(79,519名参与者)队列。参加CKD预后联盟的队列。糖尿病和高血压的状况，CKD流行病学协作2009年的EGFR，肌酐方程，尿ACR，以及相互作用。AKI患者住院，使用COX比例风险模型估计AKI的危险比(HR)，随机效应荟萃分析合并结果。在平均4年的随访期内，普通人群中有16,480次AKI发作，CKD队列中有2,087次发作。低EGFR和高ACR与有或无糖尿病和有或无高血压的AKI风险较高相关。与非糖尿病患者常见的EGFR 80毫升/分钟/1.73平方米的参考值相比，糖尿病患者在任何水平的EGFR下，AKI的HRs都较高。与非糖尿病患者相比，所有ACR水平的糖尿病患者也是如此。在无糖尿病患者中，EGFR较低的AKI的风险梯度大于有糖尿病患者，但与无糖尿病患者与有糖尿病患者的ACR较高的情况相似。当EGFR>60ml/min/1.73m2时，高血压患者发生AKI的风险高于非高血压患者。然而，在无高血压的患者中，EGFR较低和ACR较高的AKI的风险梯度较大。AKI由诊断代码标识。在有或没有糖尿病或高血压的个体中，较低的EGFR和较高的ACR与较高的AKI风险相关。
Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain. Meta-analysis of cohort studies. 8 general population (1,285,045 participants) and 5 CKD (79,519 participants) cohorts. Cohorts participating in the CKD Prognosis Consortium. Diabetes and hypertension status, eGFR by the CKD Epidemiology Collaboration 2009 creatinine equation, urine ACR, and interactions. Hospitalization with AKI, using Cox proportional hazards models to estimate hazard ratios (HR) of AKI and random effects meta-analysis to pool results. Over a mean follow-up period of 4 years, there were 16,480 episodes of AKI in the general population and 2,087 episodes in the CKD cohorts. Low eGFR and high ACR were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR 80 mL/min/1.73m2 in non-diabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared to non-diabetic patients. The risk gradient for AKI with lower eGFR was greater in those without diabetes than with diabetes, but similar with higher ACR in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFR greater than 60 ml/min/1.73m2 than those without hypertension. However, the risk gradients for AKI with both lower eGFR and higher ACR were greater for those without than with hypertension. AKI identified by diagnostic code. Lower eGFR and higher ACR are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.