Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS).
Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS).
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DOI：
10.1053/j.ajkd.2016.02.046
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Correa A
中科院分区：
文献类型：
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作者：
Young BA;Katz R;Boulware LE;Kestenbaum B;de Boer IH;Wang W;Fülöp T;Bansal N;Robinson-Cohen C;Griswold M;Powe NR;Himmelfarb J;Correa A
肾功能快速下降存在种族差异，但对非裔美国人中与快速下降相关的因素知之甚少。更好地了解早期肾功能丧失的潜在可改变的危险因素可能有助于减轻这一高危人群的肾衰竭负担。前瞻性队列研究。3653名非裔美国人参加了杰克逊心脏研究(JHS)，他们的肾功能数据来自三项检查中的两项(2000-2004年和2009-2013年)。根据CKD-EPI肌酐方程计算估计的肾小球滤过率(EGFR)。人口统计学、社会经济状况、生活方式、肾衰竭的临床危险因素。快速下降被定义为≥在随访期间EGFR值下降30%。我们在多变量模型中量化了风险因素与快速下降的关联。临床(收缩压、蛋白尿[白蛋白-肌酐比值])和可改变的危险因素。平均年龄54±12岁，男性占37%，平均体重指数31.8±7.1 kg/m2，19%有糖尿病，平均EGFR为96.0±20ml/min/1.73m2，年递减率为1.27ml/min/1.73m2。那些快速下降的人(11.5%)比那些非快速下降的人年龄更大，更有可能是低/中等收入者，有更高的收缩压和更大的DM。与≥下降30%相关的因素有：年龄较大(调整后OR为1.51；95%CI，1.34-1.71)；心血管疾病(调整后OR为1.53；95%CI，1.12-2.10)；较高的收缩压(调整OR为每17 mm Hg以上，1.22；95%CI为1.06-1.41)；糖尿病(调整OR为2.63；95%CI为2.02-3.41)、吸烟(调整OR为1.60；95%可信区间为1.10~2.31)，白蛋白/肌酐比值为30 mg/g(调整后OR为1.55；95%可信区间为1.08~1.21)。相反，结果并不支持腰围、C反应蛋白和体力活动与快速下降的联系。第二次检查(2005-2008年)时没有进行研究中期的肌酐测定。在JHS中，非裔美国人的异质性迅速下降。针对潜在可改变因素的干预可能有助于降低肾衰竭的发生率。
Racial differences in rapid kidney function decline exist, but less is known regarding factors associated with rapid decline among African Americans. A greater understanding of potentially modifiable risk factors for early kidney function loss may help reduce the burden of kidney failure in this high-risk population. Prospective cohort study. 3653 African-American participants enrolled in the Jackson Heart Study (JHS) with kidney function data from two of three examinations (2000-2004 and 2009-2013). Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI creatinine equation. Demographics, socioeconomic status, lifestyle, clinical risk factors for kidney failure. Rapid decline was defined as a ≥ 30% decline in eGFR during follow-up. We quantified the association of risk factors with rapid decline in multivariable models. Clinical (systolic blood pressure, albuminuria [albumin-creatinine ratio]) and modifiable risk factors. Mean age was 54 ± 12 (SD) years, 37% were male, average body mass index was 31.8 ± 7.1 kg/m2, 19% had diabetes mellitus (DM) and mean eGFR was 96.0 ±20 ml/min/1.73m2 with an annual rate of decline of 1.27 ml/min/1.73m2. Those with rapid decline (11.5%) were older, more likely to be of low/middle income, had higher systolic blood pressure, and greater DM than those with non-rapid decline. Factors associated with ≥30% decline were older age (adjusted OR per 10 years older, 1.51; 95% CI, 1.34-1.71); cardiovascular disease (adjusted OR, 1.53; 95% CI, 1.12-2.10), higher systolic blood pressure (adjusted OR per 17 mm Hg greater, 1.22; 95% CI, 1.06-1.41); DM (adjusted OR, 2.63; 95% CI, 2.02-3.41), smoking (adjusted OR, 1.60; 95% CI, 1.10-2.31), and albumin-creatinine ratio > 30 mg/g (adjusted OR, 1.55; 95% CI, 1.08-1.21). Conversely, results did not support associations of waist circumference, C-reactive protein, and physical activity with rapid decline. No mid study creatinine measurement at examination 2 (2005-2008). Rapid decline heterogeneity existed among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.