Chronic Kidney Disease and the Risk of Incident Gout Among Middle-Aged Men A Seven-Year Prospective Observational Study
Chronic Kidney Disease and the Risk of Incident Gout Among Middle-Aged Men A Seven-Year Prospective Observational Study
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DOI：
10.1002/art.38171
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发表时间：
2013-12-01
影响因子：
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通讯作者：
Krishnan, Eswar
中科院分区：
文献类型：
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作者：
Krishnan, Eswar
目的肾脏是人体尿酸盐排泄的主要器官。令人惊讶的是，很少有研究评估肾小球滤过率(GFR)降低和/或肾脏损害是否与痛风的高发病率相关，这项研究就是为了解决这个问题。方法采用多风险因素干预试验患者的7年随访数据，该试验是一项针对12,866名年龄在35-57岁的男性进行的心血管疾病一级预防试验。痛风的存在是由最初试验中的研究医生确定的。慢性肾脏疾病的定义标准类似于国家肾脏基金会提出的标准。在考虑潜在混杂因素的影响后，使用Cox比例风险回归模型评估痛风与慢性肾脏疾病之间的关联。结果在76,602人年的随访中，共有722例医生诊断的痛风事件。慢性肾脏疾病患者的痛风标化发病率为1217(95%可信区间[95%CI]1,191-1,244)。慢性肾病患者的调整危险比(HR)为1.61(95%可信区间为1.60~1.61)。GFR估计值的每一个标准差下降都与心率1.43相关(95%可信区间1.35-1.51)。包括血尿酸水平，以及尿酸-慢性肾脏疾病相互作用时间，作为第二个分析中的变量，不会减弱HR。蛋白尿和血尿是肾脏损害的两个标志，与痛风的风险增加相关，独立于估计的GFR。结论慢性肾脏疾病表现为肾小球功能降低或尿中存在血液或蛋白质增加痛风事件的风险。
ObjectiveThe kidney is the major organ that facilitates excretion of urate in humans. Surprisingly, few studies have assessed whether a reduced glomerular filtration rate (GFR) and/or kidney damage is associated with a higher incidence of gout, and this study was undertaken to address this question.MethodsData from a 7-year followup of patients enrolled in the Multiple Risk Factor Intervention Trial, a primary prevention trial for cardiovascular disease among 12,866 men ages 35-57 years, were used for the present investigation. Presence of gout was determined by the study physicians from the original trial. Chronic kidney disease was defined using criteria similar to those proposed by the National Kidney Foundation. The Cox proportional hazards regression model was used to assess the association between gout and chronic kidney disease, after accounting for the effects of potential confounders.ResultsOverall, there were 722 cases of physician- diagnosed incident gout over 76,602 person-years of followup. The standardized incidence ratio of gout among those with chronic kidney disease was 1,217 (95% confidence interval [95% CI] 1,191-1,244). The adjusted hazard ratio (HR) among those with chronic kidney disease was 1.61 (95% CI 1.60-1.61). Each standard deviation decline in the estimated GFR was associated with an HR of 1.43 (95% CI 1.35-1.51). Including the serum urate level, as well as the urate-chronic kidney disease interaction term, as variables in the second analysis did not attenuate the HR. Proteinuria and hematuria, two markers of kidney damage, were associated with an elevated risk of gout independent of the estimated GFR.ConclusionChronic kidney disease manifesting as reduced glomerular function or as presence of blood or protein in the urine increases the risk of incident gout.