Urinary Biomarkers of Kidney Tubular Damage and Risk of Cardiovascular Disease and Mortality in Elders.
Urinary Biomarkers of Kidney Tubular Damage and Risk of Cardiovascular Disease and Mortality in Elders.
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DOI：
10.1053/j.ajkd.2017.12.013
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Shlipak MG
中科院分区：
文献类型：
--
作者：
Jotwani V;Katz R;Ix JH;Gutiérrez OM;Bennett M;Parikh CR;Cummings SR;Sarnak MJ;Shlipak MG
新的尿生物标志物能够早期检测肾小管损伤，但其对不良心血管结局的预后价值尚不确定。我们假设，肾小管损伤（通过尿α1-微球蛋白（α 1 m）、III型前胶原氨基末端前肽（PIIINP）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）测量）与老年人心血管事件和死亡率的风险较高相关。病例队列研究本研究包括一个随机选择的子队列（n=502），CVD病例（n=245）和心力衰竭病例（n=220），来自健康、衰老和身体成分（健康ABC）研究。使用基线尿α 1 m、PIIINP和NGAL浓度的CVD事件、心力衰竭和全因死亡考克斯比例风险模型评价生物标志物与每种结局的相关性。基线时，平均年龄为74岁，eGFR为73 ml/min/1.73 m2。在调整人口统计学、eGFR、ACR和其他心血管风险因素后，生物标志物每增加一倍与以下CVD的校正风险比（HR）相关：α 1 m，1.51（95% CI，1.16-1.96）; PIIINP，1.21（1.00-1.46）; NGAL，1.12（1.05-1.20）。在中位随访12.4年的亚队列中有248例死亡。每种生物标志物（HR/倍增）与全因死亡率的校正相关性为：α 1 m，1.29（95% CI，1.10-1.51）; PIIINP，1.05（95%，0.94-1.18）; NGAL，1.07（95% CI，1.02-1.12）。多变量校正后，生物标志物与心力衰竭无统计学显著相关性。在单个时间点测量尿液生物标志物;无可用的验证队列。肾小管损害是老年人心血管疾病和死亡的独立危险因素。未来的研究应探讨肾小管损伤可能对心血管风险产生不利影响的机制。
Novel urinary biomarkers have enabled earlier detection of kidney tubular damage, but their prognostic value for adverse cardiovascular outcomes is uncertain. We hypothesized that tubular damage, measured by urine α1-microglobulin (α1m), amino-terminal propeptide of type III procollagen (PIIINP), and neutrophil gelatinase-associated lipocalin (NGAL), would be associated with higher risks for cardiovascular events and mortality among elders. Case-cohort study This study included a randomly selected subcohort (n=502), CVD cases (n=245), and heart failure cases (n=220) from the Health, Aging, and Body Composition (Health ABC) Study. Baseline urine concentrations of α1m, PIIINP, and NGAL Incident CVD, heart failure, and all-cause mortality Cox proportional hazards models were used to evaluate biomarker associations with each outcome. At baseline, the mean age was 74 years and eGFR was 73 ml/min/1.73m2. After adjustment for demographics, eGFR, ACR, and other cardiovascular risk factors, each doubling in biomarker was associated with the following adjusted hazard ratios (HRs) for CVD: α1m, 1.51 (95% CI, 1.16-1.96); PIIINP, 1.21 (1.00-1.46); NGAL, 1.12 (1.05-1.20). There were 248 deaths in the subcohort over a median follow-up of 12.4 years. The adjusted associations of each biomarker (HR per doubling) with all-cause mortality were: α1m, 1.29 (95% CI, 1.10-1.51); PIIINP, 1.05 (95%, 0.94-1.18); NGAL, 1.07 (95% CI, 1.02-1.12). The biomarkers did not have statistically significant associations with heart failure after multivariable adjustment. Urine biomarkers were measured at a single time point; no validation cohort available. Kidney tubular damage is an independent risk factor for CVD and death among elders. Future studies should investigate mechanisms by which renal tubular damage may adversely impact cardiovascular risk.
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影响因子：
39.2
作者：
Nickolas, Thomas L.;O'Rourke, Matthew J.;Barasch, Jonathan
通讯作者：
Barasch, Jonathan
DOI：
10.1053/j.ajkd.2012.05.014
发表时间：
2012-12
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Peralta CA;Katz R;Bonventre JV;Sabbisetti V;Siscovick D;Sarnak M;Shlipak MG
通讯作者：
Shlipak MG
影响因子：
168.9
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.
通讯作者：
Gansevoort, Ron T.
影响因子：
8.8
作者：
Parikh, C. R.;Jani, A.;Devarajan, P.
通讯作者：
Devarajan, P.
影响因子：
168.9
作者：
Mishra, J;Dent, C;Devarajan, P
通讯作者：
Devarajan, P