Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency
Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency
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DOI：
10.1046/j.1523-1755.1999.00773.x
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发表时间：
1999-12-01
影响因子：
19.6
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Culleton, BF;Larson, MG;Levy, D
背景轻度肾功能不全（RI）患者的心血管疾病（CVD）患病率及相关危险因素知之甚少。此外，与社区轻度RI相关的长期结果尚未被描述。在6233名成人参与者中测量了血清肌酐（S-Cr）（平均年龄54岁，54%为女性）。轻度RI定义为男性S-Cr 136至265 μ mol/L（1.5至3.0 mg/dl），女性S-Cr 120至265 μ mol/L（1.4至3.0 mg/dl）。轻度RI的下限由我们样本中健康亚组的性别特异性第95百分位数S-Cr值定义。选择轻度RI的上限，以排除更晚期肾衰竭的受试者。考克斯比例风险分析用于确定基线RI与CVD和全因死亡率的关系。基线时，8.7%的男性（N = 246）和8.0%的女性（N = 270）有轻度RI。轻度RI的受试者中有19%患有心血管疾病。在15年的随访中，有1000例CVD事件和1406例死亡。在女性中，轻度RI与CVD事件风险增加[风险比（HR）1.04，95% CI，0.79至1.37]或全因死亡率（HR 1.08，95% CI，0.87至1.34）无关。在男性中，轻度RI与CVD事件无显著相关性（HR 1.17，95%CI，0.85 - 1.57），但在年龄校正（HR 1.42，95%CI，1.12 - 1.79）和多变量校正（HR 1.31，95%CI，1.02 - 1.67）分析中，轻度RI与全因死亡率相关。轻度RI在社区中很常见，并且与CVD的高患病率相关。RI与不良结局风险的相关性与共存的CVD和CVD危险因素密切相关。
Background. Little is known about the prevalence of cardiovascular disease (CVD) and associated risk factors in individuals with mild renal insufficiency (RI). Furthermore, the longterm outcomes associated with mild RI in the community have not been described.Methods. Serum creatinine (S-Cr) was measured in 6233 adult participants of the Framingham Heart Study (mean age 54 years, 54% women). Mild RI was defined as S-Cr 136 to 265 mu mol/liter (1.5 to 3.0 mg/dl) in men and 120 to 265 mu mol/liter (1.4 to 3.0 mg/dl) in women. The lower limits for mild RI were defined by the sex-specific 95th percentile S-Cr values in a healthy subgroup of our sample. The upper limit for mild RI was chosen to exclude those subjects with more advanced renal failure. Cox proportional hazards analyses were used to determine the relationship of baseline RI to CVD and all-cause mortality.Results. At baseline, 8.7% of men (N = 246) and 8.0% of women (N = 270) had mild RI. Nineteen percent of the subjects with mild RI had prevalent CVD. During 15 years of followup, there were 1000 CVD events and 1406 deaths. In women, mild RI was not associated with increased risk for CVD events [hazards ratio (HR) 1.04, 95% CI, 0.79 to 1.37] or all-cause mortality (HR 1.08, 95% CI, 0.87 to 1.34). In men, mild RI showed no significant associations with CVD events (HR 1.17, 95% CI, 0.85 to 1.57), but it was associated with all-cause mortality in age-adjusted (HR 1.42, 95% CI, 1.12 to 1.79) and multivariable adjusted (HR 1.31,95% CI, 1.02 to 1.67) analyses.Conclusion. Mild RI in the community is common and is associated with a high prevalence of CVD. The association of RI with risk for adverse outcomes is strongly related to coexisting CVD and CVD risk factors.