Combined association of albuminuria and cystatin C-based estimated GFR with mortality, coronary heart disease, and heart failure outcomes: the Atherosclerosis Risk in Communities (ARIC) Study.
Combined association of albuminuria and cystatin C-based estimated GFR with mortality, coronary heart disease, and heart failure outcomes: the Atherosclerosis Risk in Communities (ARIC) Study.
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DOI：
10.1053/j.ajkd.2012.03.011
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Astor BC
中科院分区：
文献类型：
--
作者：
Waheed S;Matsushita K;Sang Y;Hoogeveen R;Ballantyne C;Coresh J;Astor BC
血清胱抑素C水平与临床结局的相关性强于血清肌酐水平。然而，关于基于半胱氨酸蛋白酶抑制剂C的估计肾小球滤过率（eGFRcys）和白蛋白尿与临床结局的联合相关性知之甚少，特别是在低于当前慢性肾脏疾病（CKD）临界值的水平下。前瞻性队列。10，403名ARIC（社区动脉粥样硬化风险）研究参与者随访了中位数为10.2年。eGFRcys，蛋白尿。死亡率、冠心病（CHD）和心力衰竭，以及任何这些单独结局的复合结局。eGFRcys降低和白蛋白尿均与复合结局、死亡率、CHD和心力衰竭独立相关。尽管在无蛋白尿的情况下，eGFRcys为75-89 mL/min/1.73 m2（白蛋白-肌酐比值[ACR] <10 mg/g）或白蛋白尿，ACR为10-29 mg/g，eGFRcys正常与eGFRcys为90 - 104 mL/min/1.73 m2和ACR <10 mg/g相比，（90 - 104 mL/min/1.73 m2）与任何结局均无显著相关性，在eGFRcys为75-89 mL/min/1.73 m2且ACR为10-29 mg/g的患者中，每种结局的风险均显著较高（死亡率HR为1.4 [95% CI，1.1-2.0]; CHD HR为1.9 [95% CI，1.4-2.6];心力衰竭HR为1.8 [95% CI，1.2-2.7]）。结合这两种标志物改善了所有结局的风险分类（P < 0.001），即使在那些没有明显CKD的患者中也是如此。只有一个胱抑素C的测量。轻度降低的eGFRcys和轻度蛋白尿独立地导致死亡率、CHD和心力衰竭的风险。即使是轻微降低的eGFRcys（75-89 mL/min/1.73 m2）也与轻度白蛋白尿的风险增加相关。结合这2种标志物有助于改善风险分层，即使在那些没有临床CKD的患者中也是如此。
Serum cystatin C level has been shown to have a stronger association with clinical outcomes than serum creatinine level. However, little is known about the combined association of cystatin C–based estimated glomerular filtration rate (eGFRcys) and albuminuria with clinical outcomes, particularly at levels lower than current chronic kidney disease (CKD) cutoffs. Prospective cohort. 10,403 ARIC (Atherosclerosis Risk in Communities) Study participants followed up for a median of 10.2 years. eGFRcys, albuminuria. Mortality, coronary heart disease (CHD), and heart failure, as well as a composite of any of these separate outcomes. Both decreased eGFRcys and albuminuria were associated independently with the composite outcome, as well as mortality, CHD, and heart failure. Although eGFRcys of 75-89 mL/min/1.73 m2 in the absence of albuminuria (albumin-creatinine ratio [ACR] <10 mg/g) or albuminuria with ACR of 10-29 mg/g with normal eGFRcys (90-104 mL/min/1.73 m2) was not associated significantly with any outcome compared with eGFRcys of 90-104 mL/min/1.73 m2 and ACR <10 mg/g, the risk of each outcome was significantly higher in those with both eGFRcys of 75-89 mL/min/1.73 m2 and ACR of 10-29 mg/g (for mortality, HR of 1.4 [95% CI, 1.1-2.0]; for CHD, HR of 1.9 [95% CI, 1.4-2.6]; for heart failure, HR of 1.8 [95% CI, 1.2-2.7]). Combining the 2 markers improved risk classification for all outcomes (P < 0.001), even in those without overt CKD. Only one measurement of cystatin C. Mildly decreased eGFRcys and mild albuminuria independently contributed to the risk of mortality, CHD, and heart failure. Even minimally decreased eGFRcys (75-89 mL/min/1.73 m2) is associated with increased risk in the presence of mild albuminuria. Combining the 2 markers is useful for improved risk stratification even in those without clinical CKD.
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影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
DOI：
10.1053/j.ajkd.2011.02.391
发表时间：
2011-07
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Blecker S;Matsushita K;Köttgen A;Loehr LR;Bertoni AG;Boulware LE;Coresh J
通讯作者：
Coresh J
影响因子：
168.9
作者：
Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
13.6
作者：
Kottgen, Anna;Russell, Stuart D.;Coresh, Josef
通讯作者：
Coresh, Josef
影响因子：
13.2
作者：
Stevens, Lesley A.;Coresh, Josef;Levey, Andrew S.
通讯作者：
Levey, Andrew S.