Atherosclerotic risk factors and renal function in the elderly: the role of hyperfibrinogenaemia and smoking. Results from the Italian Longitudinal Study on Ageing (ILSA)
Atherosclerotic risk factors and renal function in the elderly: the role of hyperfibrinogenaemia and smoking. Results from the Italian Longitudinal Study on Ageing (ILSA)
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DOI：
10.1093/ndt/gfh553
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发表时间：
2005-01-01
影响因子：
6.1
通讯作者：
Grigoletto, F
中科院分区：
文献类型：
--
作者：
Baggio, B;Budakovic, A;Grigoletto, F
背景我们研究了心血管疾病和危险因素与病理水平和血清肌酐（SCr）的显着变化之间的关联，在一个大的流行阶段和纵向阶段的社区为基础的样本的老年意大利人口（H-SA研究）显示没有临床证据的肾功能损害。对2981例年龄在65-84岁之间的受试者进行了患病率阶段，这些受试者的肾脏疾病呈阴性，具有可用的SCr值，并具有关于其心血管风险因素的完整临床信息。其中，371人被认为是“健康”的，因为他们没有受到心血管疾病或糖尿病的影响，而2610人的心血管疾病检测呈阳性，被认为是“疾病”。在健康参考样本中计算SCr的性别特异性第95位数（临界点），以定义正常SCr值的上限。然后估计值超过临界点值的患病受试者的分布和患病率。从患病样本中分析了超过临界点水平的值与病理或临床状况之间的关联。对1906名具有SCr值和足够临床信息的受试者进行了纵向研究。在纵向队列中评估SCr增加>26.5 mumol/l的发生率。在健康受试者中，男性第95个SCr值（截止点）为123.8 mumol/l，女性为97.2 mumol/l。在患病受试者中，SCr值超过临界点的患病率在男性中为4.6%，在女性中为9.3%。Logistic回归分析中，与临界点以上SCr值相关的自变量为：年龄>75岁[比值比（OR）= 2.2; 95%置信区间（CI）= 1.5-3.4]，下肢动脉粥样硬化（OR=2.0; 95%CI = 1.2-3.3），脑血管疾病（OR = 1.9; 95% CI = 1.2-3.3），血管紧张素转换酶（ACE）抑制剂药物（OR=1.8; 95% CI = 1.2-2.8），纤维蛋白原值>3.5 g/l（OR=1.2; 95% CI = 1.2-2.7）和利尿剂治疗（OR = 1.6; 95% CI = 1.1-2.4）。经过平均3.6年的随访，多因素Logistic回归分析显示，肾功能病理性丧失的危险因素（SCr升高>26.5 mumol/l）：目前吸烟者>20支/天（OR= 2.3; 95% CI = 1.0-5.3），纤维蛋白原值>3.5 g/l（OR = 2.2; 95%CI = 1.6-3.3）、糖尿病（OR = 1.8; 95%CI = 1.1-2.8）、年龄>75岁（OR = 1.7; 95%CI 1.2-2.4）和单纯收缩期高血压（OR 1.6; 95%CI = 1.0-2.6）。在纵向阶段检查肾功能的损失似乎是独立的基线SCr水平。目前的患病率和纵向研究表明，老年受试者中与年龄相关的肾功能下降与并存的心血管疾病和危险因素有关。这些观察结果应纳入临床实践，因为当采取适当措施时，可以预防和/或改变某些对肾功能有害的因素，如吸烟、纤维蛋白原水平改变和收缩压升高。
Background. We examined associations between cardiovascular diseases and risk factors with pathological levels of and significant changes in serum creatinine (SCr) in a large prevalence phase and longitudinal phase community-based sample of an elderly Italian population (H-SA Study) showing no clinical evidence of renal impairment.Methods. The prevalence phase was performed on 2981 subjects, aged 65-84 years, who were negative for renal diseases, had available SCr values and had complete clinical information on their cardiovascular risk factors. Of these, 371 were considered 'healthy' since they were not affected by cardiovascular diseases or diabetes, whereas 2610 tested positive for cardiovascular diseases and were considered 'diseased'. The sex-specific 95th percentiles for SCr (cut-off points) were calculated in the healthy reference sample to define the upper limit for normal SCr values. The distribution and prevalence of diseased subjects having values over the cut-off point values were then estimated. Associations between values over the cutoff point levels and pathological or clinical conditions were analysed from the diseased sample. The longitudinal phase was carried out on 1906 subjects who had SCr values and sufficient clinical information for our investigation. The incidence of an increase of >26.5 mumol/l of SCr was evaluated in the longitudinal cohort.Results. In healthy subjects, the 95th SCr percentiles (cut-off points) were 123.8 mumol/l in men and 97.2 mumol/l in women. In diseased subjects, the prevalence of SCr values over the cut-off point was 4.6% in men and 9.3% in women. In logistic regression analysis, independent variables that correlated with over the cut-off point SCr values were: age >75 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.5-3.4], atherosclerosis of the lower limbs (OR=2.0; 95% Cl = 1.2-3.3), cerebrovascular disease (OR = 1.9; 95% Cl = 1.2-3.3), angiotensin-converting enzyme (ACE) inhibitor medication (OR=1.8; 95% CI = 1.2-2.8), fibrinogen values >3.5 g/l (OR=1.2; 95% CI = 1.2-2.7) and diuretic treatment (OR = 1.6; 95% CI = 1.1-2.4). After a mean 3.6 years follow-up, multiple logistic regression analysis showed that risk factors for pathological loss of renal function (rise of SCr >26.5 mumol/l) were: current smokers >20 cigarettes/ day (OR= 2.3; 95% CI = 1.0-5.3), fibrinogen values >3.5 g/l (OR = 2.2; 95% CI = 1.6-3.3), diabetes (OR = 1.8; 95% CI = 1.1-2.8), age >75 years (OR = 1.7; 95% CI 1.2-2.4) and isolated systolic hypertension (OR 1.6; 95% CI = 1.0-2.6). The loss of renal function examined during the longitudinal phase appeared to be independent of baseline SCr levels.Conclusion. The present prevalence and longitudinal studies show that age-associated decline in renal function in elderly subjects is associated with coexisting cardiovascular diseases and risk factors. These observations should be incorporated into clinical practice since some of the factors detrimental to kidney function, such as smoking, altered fibrinogen levels and elevated systolic blood pressure, can be prevented and/or modified when appropriate measures are taken.