Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans
Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans
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DOI：
10.1053/j.ajkd.2008.01.013
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发表时间：
2008-05-01
影响因子：
13.2
通讯作者：
McClellan, William
中科院分区：
文献类型：
--
作者：
Lea, Janice;Cheek, Deanna;McClellan, William
背景：慢性肾脏疾病(CKD)在非裔美国人中更有可能进展为肾衰竭(终末期肾脏疾病)，尽管原因尚不清楚。代谢综合征是糖尿病和心血管疾病发展的危险因素，最近被认为与慢性肾脏病的发生有关。本研究的目的是检验代谢综合征是否与非裔美国人高血压肾病的进展有关。设计与参与者：目前的研究设计是对非裔美国人高血压和肾脏疾病研究的二次分析，这是一项针对患有高血压的非裔美国人的血压目标和药物的随机对照试验。预测因素：代谢综合征是根据修订的国家胆固醇教育计划指南定义的。结果：肾小球滤过率下降50%或25mL/min/1.73m(2)，终末期肾脏疾病(开始透析治疗或移植)，死亡，结果：842名受试者进入分析，其中41.7%符合代谢综合征标准。符合代谢综合征标准的受试者蛋白尿水平更高。COX回归分析调整了年龄、性别、肾小球滤过率和除蛋白尿以外的其他重要协变量，显示代谢综合征患者达到综合结果的时间风险增加了31%，95%的可信区间为1.03至1.7(P=0.03)。调整蛋白尿后，效果减弱至16%(95%可信区间，0.9%至1.5%)，不再显著(P=0.2)，调整随机治疗组(血压目标或抗高血压药物)后效果不变。限制：腰围不足是腹型肥胖更好的替代指标。结论：总而言之，代谢综合征与高血压非裔美国人的蛋白尿有关，但与CKD的进展无关。
Background: Chronic kidney disease (CKD) is more likely to progress to kidney failure (end-stage renal disease) in African Americans, although the reasons for this are unclear. Metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease and recently was linked to incident CKD. The purpose of this study is to examine whether metabolic syndrome is associated with kidney disease progression in hypertensive African Americans.Design & Participants: The current study design is a secondary analysis of the African-American Study of Hypertension and Kidney Disease, a randomized controlled trial of blood pressure goal and agents in hypertensive African Americans with CKD.Predictors: Metabolic syndrome was defined according to the modified National Cholesterol Education Program guidelines.Outcomes: Decrease in glomerular filtration rate of 50% or 25 mL/min/1.73 m(2), end-stage renal disease (initiation of dialysis therapy or transplantation), death, or a composite outcome of all 3.Results: 842 subjects were included in this analysis, and 41.7% met criteria for metabolic syndrome. Subjects meeting criteria for metabolic syndrome had greater levels of proteinuria. Cox regression analyses adjusted for age, sex, glomerular filtration rate, and other significant covariates except for proteinuria indicated a 31% increased risk, with a 95% confidence interval of 1.03 to 1.7(P = 0.03) for time to reach the composite outcome in those with metabolic syndrome. Adjusting for proteinuria, the effect was abated to 16% (95% confidence interval, 0.9 to 1.5), no longer remained significant (P = 0.2), and was unchanged by adjusting randomized treatment group (blood pressure goal or antihypertensive drug).Limitations: Lack of waist circumference as a better surrogate of abdominal obesity.Conclusions: In summary, metabolic syndrome is associated with proteinuria in hypertensive African Americans, but is not independently associated with CKD progression.