A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury.
A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury.
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DOI：
10.1053/j.ajkd.2015.02.337
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
CKD Prognosis Consortium
中科院分区：
文献类型：
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作者：
Grams ME;Sang Y;Ballew SH;Gansevoort RT;Kimm H;Kovesdy CP;Naimark D;Oien C;Smith DH;Coresh J;Sarnak MJ;Stengel B;Tonelli M;CKD Prognosis Consortium
急性肾损伤（AKI）是一个严重的全球公共卫生问题。我们的目的是量化与估计肾小球滤过率 (eGFR)、白蛋白尿（白蛋白肌酐比 [ACR]）、年龄、性别和种族（非裔美国人和白种人）相关的 AKI 风险。协作荟萃分析。 8 个一般人群队列（1,285,049 名参与者）和 5 个慢性肾病 (CKD) 队列（79,519 名参与者）。可用的 eGFR、ACR 和 ≥50 个 AKI 事件。年龄、性别、种族、eGFR、尿液 ACR 和相互作用。因 AKI 住院，使用 Cox 比例风险模型估计 AKI 的 HR，并使用随机效应荟萃分析汇总结果。平均随访 4 年期间，16,480 名 (1.3%) 普通人群队列参与者患有 AKI； 2,087 名 (2.6%) CKD 参与者在平均随访 1 年期间出现 AKI。较低的 eGFR 和较高的 ACR 与 AKI 密切相关。与 eGFR 80 ml/min/1.73 m2 相比，eGFR 45 ml/min/1.73 m2 时 AKI 的调整 HR 为 3.35（95% CI，2.75-4.07）。与 ACR 5 mg/g 相比，ACR 300 mg/g 发生 AKI 的风险为 2.73（95% CI，2.18-3.43）。年龄较大与 AKI 风险较高相关，但这种效应在 eGFR 较低或 ACR 较高时减弱。男性与较高的 AKI 风险相关，较低的 eGFR 略有减弱，但较高的 ACR 没有减弱。非洲裔美国人在 eGFR 水平较高和 ACR 水平较高时， AKI 风险较高。只有 2 个一般人群队列可以对按种族进行分析做出贡献；由诊断代码识别的 AKI。 eGFR 降低和 ACR 升高是 AKI 的一致且强烈的危险因素，而在 CKD 的晚期阶段，AKI 与年龄、性别和种族的关联可能较弱。
Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and Caucasian). Collaborative meta-analysis. 8 general population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). Available eGFR, ACR, and ≥50 AKI events. Age, sex, race, eGFR, urine ACR, and interactions. Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random effects meta-analysis to pool results. 16,480 (1.3%) general population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR 80 ml/min/1.73 m2, the adjusted HR of AKI at eGFR 45 ml/min/1.73 m2 was 3.35 (95% CI, 2.75–4.07). Compared with ACR 5 mg/g, the risk of AKI at ACR 300 mg/g was 2.73 (95% CI, 2.18–3.43). Older age was associated with higher risk of AKI, but this effect was attenuated in lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR. Only 2 general population cohorts could contribute to analyses by race; AKI identified by diagnostic code. Reduced eGFR and increased ACR are consistent, strong risk factors for AKI whereas the associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.