Plasma lipids and risk of developing renal dysfunction: The Atherosclerosis Risk in Communities Study
Plasma lipids and risk of developing renal dysfunction: The Atherosclerosis Risk in Communities Study
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DOI：
10.1046/j.1523-1755.2000.00165.x
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发表时间：
2000-07-01
影响因子：
19.6
通讯作者：
Klag, MJ
中科院分区：
文献类型：
--
作者：
Muntner, P;Coresh, J;Klag, MJ
背景动物和体外数据表明，血脂异常在慢性肾脏疾病的发生和发展中起着重要的作用，但很少有前瞻性研究在人类中进行。我们研究了12，728名社区动脉粥样硬化风险（ARIC）参与者的血脂与血清肌酐升高0.4 mg/dL或更高的关系，男性基线血清肌酐低于2.0 mg/dL，女性低于1.8 mg/dL。在平均2.9年的随访中，191人肌酐升高0.4 mg/dL或更高，发生率为5.1/1000人年。在调整种族、性别、基线年龄、糖尿病、血清肌酐、收缩压和抗高血压药物使用后，基线时甘油三酯较高、高密度脂蛋白（HDL）和HDL-2胆固醇较低的个体肌酐升高的风险增加（所有P趋势均小于或等于0.02）。甘油三酯最高与最低四分位数的校正相对风险为1.65（95% CI，1.1，2.5，P = 0.01），HDL为0.47（95% CI，0.3，0.8，P = 0.003）。这些相关性在肌酐正常（定义为男性< 1.4 mg/dL，女性< 1.2 mg/dL）、糖尿病和非糖尿病的参与者中显著。高甘油三酯的影响与血糖无关，但在进一步调整非糖尿病患者的空腹胰岛素后，其影响较弱且不一致。高甘油三酯和低高密度脂蛋白胆固醇，但不是低密度脂蛋白胆固醇，预测肾功能不全的风险增加。这些脂质异常的治疗可能会降低早期肾脏疾病的发生率。
Background. Animal and in vitro data suggest that dyslipidemia plays an important rule in the initiation and progression of chronic renal disease, but few prospective studies have been conducted in humans.Methods. We studied the relationship of plasma lipids to a rise in serum creatinine of 0.4 mg/dL or greater in 12,728 Atherosclerosis Risk in Communities (ARIC) participants with baseline serum creatinine that was less than 2.0 mg/dL in men and less than 1.8 mg/dL in women.Results. During a mean follow-up of 2.9 years, 191 persons had a rise in creatinine of 0.4 mg/dL or greater, yielding an incidence rate of 5.1 per 1000 person years. Individuals with higher triglycerides and lower high-density lipoprotein (HDL) and HDL-2 cholesterol at baseline were at increased risk for a rise in creatinine after adjustment for race, gender, baseline age, diabetes, serum creatinine, systolic blood pressure, and antihypertensive medication use (all P trends less than or equal to 0.02). The adjusted relative risk for the highest versus lowest quartile of triglycerides was 1.65 (95 % CI, 1.1, 2.5, P = 0.01) and for HDL was 0.47 (95% CI, 0.3, 0.8, P = 0.003). These associations were significant in participants with normal creatinine (defined as < 1.4 mg/dL for men and < 1.2 mg/dL for women), with diabetes, and without diabetes. The effect of high triglycerides was independent of plasma glucose, but was weaker and less consistent after further adjustment for fasting insulin in nondiabetics.Conclusions. High triglycerides and low HDL cholesterol, but not low-density lipoprotein in cholesterol, predict an increased risk of renal dysfunction. The treatment of these lipid abnormalities may decrease the incidence of early renal disease.