Occult chronic kidney disease among persons with hypertension in the United States: data from the National Health and Nutrition Surveys 1988-1994 and 1999-2002.
Occult chronic kidney disease among persons with hypertension in the United States: data from the National Health and Nutrition Surveys 1988-1994 and 1999-2002.
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DOI：
10.1097/hjh.0b013e328360ae2d
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发表时间：
2013-06
影响因子：
4.9
通讯作者：
Shlipak MG
中科院分区：
文献类型：
--
作者：
Peralta CA;Weekley CC;Li Y;Shlipak MG
高血压指南建议使用血清肌酐和尿液试纸筛查慢性肾脏病（CKD）；这种策略可能会导致错误分类。患有隐匿性 CKD 的人 [即肌酐遗漏但半胱氨酸蛋白酶抑制剂 C 或白蛋白与肌酐比值 (ACR) 检测到的] 死亡、心血管事件和终末期肾病的风险较高。我们在 1988-1994 年（N = 2088）和 1999-2002 年（N = 737）国家健康和营养检查调查中研究了非糖尿病、高血压成人中隐匿性 CKD 患病率。我们将隐匿性 CKD 定义为半胱氨酸蛋白酶抑制剂 C (eGFRcys) 估算的肾小球滤过率低于每 1.73 平方米 60 毫升/分钟和/或 eGFRcreat 超过每 1.73 平方米 60 毫升/分钟的人中 ACR 至少为 30 毫克/克。我们通过任一标志物研究了隐匿性 CKD 患病率，按年龄、种族/民族分层，并评估了与隐匿性 CKD 存在相关的临床预测因子。 1988-1994年，隐匿性CKD在非糖尿病高血压患者中的患病率为25%，1999-2002年这一比例为22%。每个标记检测隐匿性 CKD 的能力因年龄和种族而异。胱抑素 C 在 65 岁以上人群中检测出隐匿性 CKD 的比例为 8.9%，在白人中检测出隐匿性 CKD 的比例为 3.8%。 ACR 在 45 岁以下人群中检测出隐匿性 CKD，其中 9.3% 为黑人，16.6% 为黑人，20.6% 为墨西哥裔美国人。在多变量模型中，1988-1994 年和 1999-2002 年（OR 2.9，1.8-4.6），年龄每增长 10 岁，半胱氨酸蛋白酶抑制剂 C 导致的隐匿性 CKD 患病率就会升高（OR 3.1，95% CI 2.5-3.8）。目前的高血压指南可能无法检测到大部分可通过胱抑素 C 或 ACR 识别的 CKD 高危人群。未来的研究需要评估多标志物肾组合在高血压患者中的针对性使用。
Hypertension guidelines recommend screening for chronic kidney disease (CKD) using serum creatinine and urine dipstick; this strategy may lead to misclassification. Persons with occult CKD [i.e. missed by creatinine but detected by cystatin C or albumin-to-creatinine ratio (ACR)] have higher risks for death, cardiovascular events, and end-stage renal disease. We studied occult CKD prevalence among nondiabetic, hypertensive adults in National Health and Nutrition Examination Survey 1988–1994 (N = 2088) and 1999–2002 (N = 737). We defined occult CKD as estimated glomerular filtration rate by cystatin C (eGFRcys) less than 60 ml/min per 1.73m2 and/or ACR at least 30 mg/g among persons with eGFRcreat more than 60 ml/min per 1.73m2. We studied occult CKD prevalence by either marker, stratified by age, race/ethnicity, and assessed clinical predictors associated with occult CKD presence. In 1988–1994, occult CKD was prevalent among 25% of nondiabetic hypertensive persons, and it was 22% in 1999–2002. Each marker’s ability to detect occult CKD varied by age and race. Cystatin C detected occult CKD among 8.9% of persons more than 65 years, and among 3.8% of whites. ACR detected occult CKD among 9.3% of persons less than 45 years, 16.6% of Blacks, and 20.6% of Mexican–Americans. In multivariate models, each decade of advancing age was associated with a higher occult CKD prevalence by cystatin C (OR 3.1, 95% CI 2.5–3.8) in 1988–1994 and 1999–2002 (OR 2.9, 1.8–4.6). Current hypertension guidelines may fail to detect a large proportion of high-risk individuals with CKD who can be identified by cystatin C or ACR. Future studies are needed to evaluate targeted use of multimarker renal panels among hypertensives.