Cross-classification of microalbuminuria and reduced glomerular filtration rate - Associations between cardiovascular disease risk factors and clinical outcomes
Cross-classification of microalbuminuria and reduced glomerular filtration rate - Associations between cardiovascular disease risk factors and clinical outcomes
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DOI：
10.1001/archinte.167.13.1386
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发表时间：
2007-07-09
影响因子：
--
通讯作者：
Fox, Caroline S.
中科院分区：
文献类型：
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作者：
Foster, Meredith C.;Hwang, Shih-Jen;Fox, Caroline S.
背景：慢性肾脏病的定义是估计肾小球滤过率降低（eGFR 降低）或微量白蛋白尿 (MA)。根据这些定义，eGFR 和 MA 降低与相关心血管疾病 (CVD) 和全因死亡率之间的一致性尚不确定。 方法：参与者（n = 2966 [52.6% 为女性]，平均年龄 59 岁）选自 Framingham 后代队列。根据 eGFR 是否存在降低，参与者被分为 4 组（女性 eGFR < 59 mL/min/1.73 m(2)，男性 < 64 mL/min/1.73 m(2) 或 MA（现货尿白蛋白与肌酐比率至少 30 mg/g）。Cox 比例风险模型用于确定每组的 CVD 事件和全因死亡率的综合风险。在参与者中，9.9% (n = 295) 的 eGFR 降低，12.2% (n = 362) 患有 MA。在 eGFR 降低的患者中，28% 患有 MA。与没有任何疾病的患者相比，eGFR 降低且患有 MA 的患者合并 CVD 和全因死亡率的风险增加（风险比 [HR] 1.7，95% 置信区间 [CI]，1.1-2.4；P = .009），而 eGFR 降低且无 MA 的患者以及 eGFR 未降低且有 MA 的患者的 HR 相似（分别为 1.3 和 1.2）。 1.1-2.6]。结论：eGFR 降低和 MA 是具有不同危险因素特征的相对常见病症，2.8% 的研究样本中存在 eGFR 降低和 MA 共存，导致 CVD 和全因死亡率的风险大幅增加，部分原因是 CVD 危险因素负担较重。
Background: Chronic kidney disease is defined by reduced estimated glomerular filtration rate (reduced eGFR) or by microalbuminuria (MA). Concordance between reduced eGFR and MA and associated cardiovascular disease (CVD) and all-cause mortality according to these definitions is uncertain.Methods: Participants (n = 2966 [52.6% were women], mean age, 59 years) were drawn from the Framingham Offspring Cohort. Participants were classified into 4 groups based on the presence or absence of reduced eGFR (eGFR < 59 mL/min/ 1.73 m(2) in women, < 64 mL/min/ 1.73 m(2) in men or MA (spot urinary albumin to creatinine ratio of at least 30 mg/g). Cox proportional hazard models were used to determine the combined risk of CVD events and all-cause mortality for each group.Results: Of the participants, 9.9% (n = 295) had reduced eGFR, and 12.2% (n = 362) had MA. Among those with reduced eGFR, 28% had MA. Those with reduced eGFR and with MA were at increased risk for combined CVD and all cause mortality compared with those with neither condition (hazard ratio [HR] 1.7, 95% confidence interval [CI], 1.1-2.4; P = .009), whereas those with reduced eGFR and without MA and those without reduced eGFR and with MA had similar HRs (1.3 and 1.2, respectively). Those with reduced eGFR and with MA, as well as those with reduced eGFR and without MA, were at significantly increased risk of all-cause mortality (HR 2.2 [95% CI, 1.4-3.6] and HR 1.7 [95% CI, 1.1-2.6], respectively).Conclusions: Reduced eGFR and MA are relatively common conditions with different risk factor profiles. The coexistence of reduced eGFR and MA was present in 2.8% of the study sample and conferred substantial increased risk for CVD and all-cause mortality, in part because of a heavy burden of CVD risk factors.