Estimated Glomerular Filtration Rate and Albuminuria as Predictors of Outcomes in Patients With High Cardiovascular Risk A Cohort Study
Estimated Glomerular Filtration Rate and Albuminuria as Predictors of Outcomes in Patients With High Cardiovascular Risk A Cohort Study
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DOI：
10.7326/0003-4819-154-5-201103010-00005
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发表时间：
2011-03-01
影响因子：
39.2
通讯作者：
Mann, Johannes F. E.
中科院分区：
文献类型：
--
作者：
Clase, Catherine M.;Gao, Peggy;Mann, Johannes F. E.
背景资料：肾小球滤过率和白蛋白尿是心血管疾病的危险因素和肾功能的标志物。目的：研究肾小球滤过率估计值（eGFR）和尿白蛋白-肌酐比值在传统心血管危险因素之外对心血管和肾脏预后患者风险分类的贡献。设计：前瞻性队列研究，汇总了ONTARGET的所有患者（正在进行的替米沙坦单药治疗和与雷米普利联合治疗全球终点试验）和TRANSCEND（血管紧张素转换酶抑制剂不耐受心血管疾病受试者中的替米沙坦随机评估研究）。27620例55岁以上有心血管疾病记录的患者，平均随访4.6年，测量指标：基线eGFR、尿白蛋白-肌酐比值和心血管危险因素。结果为全因死亡率;心血管死亡、心肌梗死、卒中和心力衰竭住院的复合指标;长期透析;长期透析和血清肌酐水平加倍的复合指标。较低的eGFR和较高的尿白蛋白-肌酐比值与主要心血管复合终点相关（例如，校正后的风险比为2.53 [95%CI，eGFR为1.61至3.99]
Background: Glomerular filtration rate and albuminuria are risk factors for cardiovascular disease and markers of renal function.Objective: To examine the contribution of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio beyond that of traditional cardiovascular risk factors to classification of patient risk for cardiovascular and renal outcomes.Design: Prospective cohort study that pooled all patients of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in Angiotensin-Converting-Enzyme-Inhibitor Intolerant Subjects with Cardiovascular Disease).Patients: 27 620 patients older than 55 years with documented cardiovascular disease, who were followed for a mean of 4.6 years.Measurements: Baseline eGFR, urinary albumin-creatinine ratio, and cardiovascular risk factors. Outcomes were all-cause mortality; a composite of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure; long-term dialysis; and a composite of long-term dialysis and doubling of serum creatinine level.Results: Lower eGFRs and higher urinary albumin-creatinine ratios were associated with the primary cardiovascular composite outcome (for example, an adjusted hazard ratio of 2.53 [95% CI, 1.61 to 3.99] for an eGFR