Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis
Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis
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DOI：
10.1080/00365513.2019.1664761
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发表时间：
2019-09-13
影响因子：
2.1
通讯作者：
Soderberg, Stefan
中科院分区：
文献类型：
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作者：
Ljungberg, Johan;Johansson, Bengt;Soderberg, Stefan
最近，提出了一种新的方法来检测轻度肾功能损害：降低肾小球滤过率（eGFR）计算的半胱氨酸蛋白酶抑制剂C和肌酐计算的eGFR之间的比值。我们的目的是评估该比率是否与需要手术的主动脉瓣狭窄（AS）相关。我们确定了336名患者，他们首先参加了人群调查，后来接受了AS手术（调查时的中位年龄[四分位距]为59.8 [10.3]岁，手术时为68.3 [12.7]岁，48%为女性）。对于每例患者，分配两个匹配的参照物。在储存的血浆中测定胱抑素C和肌酐。估计eGFR（胱抑素C）和eGFR（肌酐）及其比值。使用条件logistic回归分析估计与eGFR（胱抑素C）和eGFR（肌酐）比值增加一个（ln）标准差相关的风险（比值比（OR）和[95%置信区间（CI）]）。高比率与需要手术的AS风险较低相关（OR [95% CI]）（OR 0.84 [0.73-0.97]），尤其是女性（0.74 [0.60-0.92] vs. 0.93 [0.76-1.13]）。在对冠状动脉疾病（CAD）进一步分层后，这种相关性在患有CAD的女性中仍然存在，但在没有CAD的女性中则不存在（分别为0.60 [0.44-0.83]和0.89 [0.65-1.23]）。总之，eGFR（胱抑素C）和eGFR（肌酐）之间的高比值与AS手术风险降低相关，尤其是在女性中。因此，肾功能轻度损害与未来需要手术的AS风险相关。
Recently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFR(cystatin C) and eGFR(creatinine) and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFR(cystatin C) and eGFR(creatinine). A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73-0.97]), especially in women (0.74 [0.60-0.92] vs. 0.93 [0.76-1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44-0.83] and 0.89 [0.65-1.23], respectively). In conclusion, a high ratio between eGFR(cystatin C) and eGFR(creatinine) was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery.