Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD
Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD
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DOI：
10.1159/000502291
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发表时间：
2019-10-01
影响因子：
2.8
通讯作者：
Han, Seung Hyeok
中科院分区：
文献类型：
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作者：
Lee, Mi Jung;Chang, Tae Ik;Han, Seung Hyeok
背景：尿液渗透压表明肾脏浓缩尿液的能力，反映加压素的抗利尿作用。然而，关于尿液渗透压与慢性肾脏病（CKD）不良肾脏结局之间关系的结果是相互矛盾的。我们在全国前瞻性 CKD 队列中研究了尿渗透压与不良肾脏结局之间的关联。方法：共有 1,999 名 CKD 患者根据尿液渗透压三分位数分为 3 组。主要结局是估计肾小球滤过率 (eGFR) 下降 50%、开始透析或肾移植的综合结果。结果：在平均 35.2 +/- 19.0 个月的随访期间，432 名 (21.6%) 患者出现主要结局；最低、中间和最高三分位数分别为 240 (36.4%)、162 (24.3%) 和 30 (4.5%)。低尿渗透压与 CKD 进展风险较高独立相关（风险比 [HR]，1.71；95% 置信区间 [CI]，1.12-2.59）。这种关联在 CKD 3-4 期患者中尤其明显（每减少 10 mosm/kg；HR，1.02；95% CI，1.00-1.03）。将尿液渗透压添加到具有常规因素的基础模型中，显着提高了预测 CKD 进展的能力（C 统计量，0.86；综合辨别改进 [IDI]，0.021；均 p < 0.001）。然而，与仅添加 eGFR 相比，同时添加尿液渗透压和 eGFR 并没有进一步提高预测能力（C 统计量，p = 0.29；IDI，p = 0.09）。结论：低尿渗透压是CKD患者肾脏不良结局的独立危险因素，但其预测能力并未超越eGFR。因此，在解释尿液渗透压的临床意义时应考虑肾功能。
Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 +/- 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.