Estimated GFR and risk of hip fracture in older men: comparison of associations using cystatin C and creatinine.
Estimated GFR and risk of hip fracture in older men: comparison of associations using cystatin C and creatinine.
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DOI：
10.1053/j.ajkd.2013.05.022
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Osteoporotic Fractures in Men Study Group
中科院分区：
文献类型：
--
作者：
Ensrud KE;Parimi N;Fink HA;Ishani A;Taylor BC;Steffes M;Cauley JA;Lewis CE;Orwoll ES;Osteoporotic Fractures in Men Study Group
较高的血清胱抑素C与绝经后白人女性髋部骨折风险增加有关，但在男性中缺乏相关数据。基于胱抑素C （eGFRcys）的估测GFR （eGFR）在预测髋部骨折风险方面是否优于基于肌酐（eGFRcr）或两者联合（eGFRcr-cys）的估测eGFR （eGFR）也不确定。嵌套case-cohort。男性骨质疏松性骨折（MrOS）研究的参与者（来自6个美国中心的5994名年龄≥65岁的男性）包括1602名男性和168名偶发髋部骨折的男性（其中51人在亚队列中）。eGFRcys、eGFRcr和eGFRcr-cys使用CKD-EPI方程计算，并按<60、60 - 74和≥75 mL/min/l分类表达。73 m2（参照组）。偶发性髋部骨折由参与者每4个月接触一次并通过x线报告确认。中位egfrys为72.9 (IQR, 60.5-85.7) mL/min/1.73 m2。在未调整的模型中，所有eGFR测量值都与髋部骨折风险增加相关。然而，在调整年龄、种族、地点和BMI后，较低的eGFRcys（但不是较低的eGFRcr或较低的eGFRcr-cys）与髋部骨折风险较高的相关性仍然存在：<60 vs.≥75 mL/min/l。73 m2， eGFRcys、eGFRcr和eGFRcr-cys的hr分别为1.96 [95% CI, 1.25-3.09]、0.84 [95% CI, 0.52-1.37]和1.08 [95% CI, 0.66-1.77]。同样，在调整年龄、种族、地点和BMI后，eGFR < 60ml /min/1.73 m2 （eGFRcys定义，而不是eGFRcr或eGFRcr-cys定义）与髋部骨折风险较高相关。eGFRcys与髋部骨折之间的关系不能用钙化激素或炎症标志物的水平来解释，但这种关系已经减弱，不再具有显著性（<60 vs.≥75 mL/min/l）。73 m2: HR 1.43；95% CI, 0.88-2.34)，考虑了其他临床危险因素和骨矿物质密度。研究结果不能推广到其他人群；可能存在残留混淆。egfrys较低的老年社区男性髋部骨折的风险增加，这在很大程度上是由于egfrys较低的男性风险因素负担更大。相比之下，较低的eGFRcr或较低的eGFRcr-cys与较高的年龄调整髋部骨折风险无关。
Higher serum cystatin C is associated with an increased risk of hip fracture in postmenopausal white women, but there is a paucity of data in men. Whether an estimated GFR (eGFR) based on cystatin C (eGFRcys) is superior in predicting hip fracture risk to an eGFR based on creatinine (eGFRcr) or the combination (eGFRcr-cys) is also uncertain. Nested case-cohort. Participants enrolled in the Osteoporotic Fractures in Men (MrOS) Study (5,994 men aged ≥65 years from six U.S. centers) including a random subcohort of 1602 men and 168 men with incident hip fractures (51 of whom were in the subcohort). eGFRcys, eGFRcr and eGFRcr-cys computed using the CKD-EPI equations and expressed in categories of <60, 60–74, and ≥75 mL/min/l.73 m2 (referent group). Incident hip fracture ascertained by participant contacts every 4 months and confirmed with radiographic reports. Median eGFRcys was 72.9 (IQR, 60.5–85.7) mL/min/1.73 m2. In unadjusted models, all measures of eGFR were associated with increased hip fracture risk. However, after adjustment for age, race, site and BMI, the association of lower eGFRcys (but not lower eGFRcr or lower eGFRcr-cys) with higher hip fracture risk remained: for <60 vs. ≥75 mL/min/l.73 m2, HRs were 1.96 [95% CI, 1.25–3.09], 0.84 [95% CI, 0.52–1.37], and 1.08 [95% CI, 0.66–1.77] for eGFRcys, eGFRcr, and eGFRcr-cys, respectively. Similarly, after adjustment for age, race, site and BMI, eGFR of <60 ml/min/1.73 m2 defined by eGFRcys but not eGFRcr or eGFRcr-cys, was associated with higher hip fracture risk. The association between eGFRcys and hip fracture was not explained by levels of calcitropic hormones or inflammatory markers, but the relationship was attenuated and no longer reached significance (for <60 vs. ≥75 mL/min/l.73 m2: HR, 1.43; 95% CI, 0.88–2.34) after consideration of additional clinical risk factors and bone mineral density. Findings not generalizable other populations; residual confounding may exist. Older community-dwelling men with lower eGFRcys have an increased risk of hip fracture that is explained in large part by greater burden of risk factors among men with lower eGFRcys. In contrast, lower eGFRcr or lower eGFRcr-cys were not associated with a higher age-adjusted hip fracture risk.
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DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
影响因子：
6.3
作者：
LaCroix AZ;Lee JS;Wu L;Cauley JA;Shlipak MG;Ott SM;Robbins J;Curb JD;Leboff M;Bauer DC;Jackson RD;Kooperberg CL;Cummings SR;Women's Health Initiative Observational
通讯作者：
Women's Health Initiative Observational
影响因子：
13.2
作者：
Dooley, Annemarie C.;Weiss, Noel S.;Kestenbaum, Bryan
通讯作者：
Kestenbaum, Bryan
DOI：
10.2215/cjn.09130912
发表时间：
2013-07-31
影响因子：
9.8
作者：
Elliott, Meghan J.;James, Matthew T.;Hemmelgarn, Brenda R.
通讯作者：
Hemmelgarn, Brenda R.
影响因子：
2.2
作者：
Orwoll, E;Blank, JB;Stone, K
通讯作者：
Stone, K