Nephrolithiasis as a Risk Factor for CKD: The Atherosclerosis Risk in Communities Study
Nephrolithiasis as a Risk Factor for CKD: The Atherosclerosis Risk in Communities Study
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DOI：
10.2215/cjn.10111014
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发表时间：
2015-11-01
影响因子：
9.8
通讯作者：
Coresh, Josef
中科院分区：
文献类型：
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作者：
Kummer, Andrew E.;Grams, Morgan;Coresh, Josef
背景与目的：先前的研究表明，有肾结石病史的人患慢性肾脏病（CKD）的风险更高，但这些研究大多针对白人人群，且未评估种族和血尿酸等重要的潜在相互作用。
设计、地点、参与者及测量方法：在社区动脉粥样硬化风险（ARIC）研究的10678名基线时无CKD的参与者（1996 - 1998年ARIC第4次随访）中，我们评估了肾结石病史（一个随时间变化的变量，由自我报告和诊断代码共同确定）与CKD发病（通过与住院记录以及美国医疗保险和医疗补助服务中心的记录相关联的诊断代码确定）之间的关联。
结果：基线时，856名参与者有肾结石病史；322人在随访期间患上肾结石。在平均12年的随访中，发生了1037例CKD事件。在人口统计学调整分析中，肾结石病史与CKD风险升高29%相关（风险比[HR]，1.29；95%置信区间[95%CI]，1.07 - 1.54），但在多变量调整后，这种关联不再具有统计学意义（HR，1.09；95%CI，0.90 - 1.32）。在血尿酸水平＜6mg/dl的参与者中，多变量调整后的关联更强（HR，0.94；95%CI，0.70 - 1.28；交互作用P值 = 0.05）。结石疾病和种族与CKD发病之间没有交互作用。
结论：在这个基于社区的队列中，总体而言肾结石不是CKD发病的独立危险因素。然而，在有结石疾病且血尿酸水平较低的参与者中，CKD风险意外升高。
Background and objectives Previous studies demonstrated a higher risk of CKD in persons with a history of kidney stones, but these studies examined mostly white populations and did not evaluate important potential interactions such as race and plasma uric acid.Design, setting, participants, & measurements In 10,678 Atherosclerosis Risk in Communities (ARIC) study participants free of CKD at baseline (ARIC visit 4 in 1996-1998), we assessed the association between a history of nephrolithiasis (a time-varying variable, defined by a combination of self-report and diagnostic codes) and incident CKD (defined by diagnostic codes from linkage to hospitalizations and US Centers for Medicare and Medicaid Services' records).Results At baseline, 856 participants had a history of nephrolithiasis; 322 developed nephrolithiasis during follow-up. Over a mean follow-up of 12 years, there were 1037 incident CKD events. Nephrolithiasis history was associated with a 29% (hazard ratio [HR], 1.29; 95% confidence interval [95% CI], 1.07 to 1.54) higher risk of CKD in demographic-adjusted analyses, but the association was no longer statistically significant after multivariable adjustment (HR, 1.09; 95% CI, 0.90 to 1.32). The multivariable-adjusted association was stronger among participants with plasma uric acid levels 6 mg/dl (HR, 0.94; 95% CI, 0.70 to 1.28; P-interaction=0.05). There was no interaction of stone disease and race with incident CKD.Conclusions In this community-based cohort, nephrolithiasis was not an independent risk factor for incident CKD overall. However, risk of CKD was unexpectedly elevated in participants with stone disease and lower plasma uric acid levels.