Albuminuria is an independent predictor of all-cause and cardiovascular mortality in the Japanese population: the Takahata study
Albuminuria is an independent predictor of all-cause and cardiovascular mortality in the Japanese population: the Takahata study
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DOI：
10.1007/s10157-013-0770-3
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发表时间：
2013-12-01
影响因子：
2.3
通讯作者：
Kubota, Isao
中科院分区：
文献类型：
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作者：
Konta, Tsuneo;Kudo, Kosuke;Kubota, Isao
蛋白尿是心血管事件和过早死亡的已知危险因素。然而，在日本人群中，尿白蛋白排泄和死亡率之间的联系尚不清楚。为了阐明这一点，我们进行了一项以社区为基础的纵向研究。这项研究包括3445名注册的日本受试者(平均年龄62.6岁)，并进行了7年的跟踪调查。白蛋白尿的定义是尿白蛋白/肌酐比值(ACR)为30 mg/g。有白蛋白尿者(n=514，14.9%)年龄较大，高血压、肥胖症和糖尿病的患病率较高，肾小球滤过率(EGFR)低于无白蛋白尿者(n=2931，85.1%)。在随访期间，138名受试者死亡。卡普兰-迈耶分析显示，全因死亡率随着尿白蛋白排泄量的增加而显著增加(对数等级检验，P<；0.001)。有蛋白尿者的死亡率显著高于无蛋白尿者(7.4vs.3.4%；对数等级检验，P<；0.001)。在调整可能的混杂因素后，COX比例风险模型分析显示，蛋白尿是全因死亡率和心血管死亡率的独立危险因素(危险比[HR]1.69，95%可信区间[CI]1.12-2.56和HR 2.27，95%可信区间1.10-4.70)，但不是非心血管死亡率的独立危险因素。在排除ACR高(千分之300毫克/克)的受试者后，这些关联被保留下来。蛋白尿是日本人群中各种原因和心血管死亡的危险因素。为了发现过早死亡的高风险受试者，测量尿白蛋白排泄量可能是有用的。
Albuminuria is a known risk factor for cardiovascular events and premature deaths. However, the association between urinary albumin excretion and mortality is unknown in the Japanese population. To clarify this, we conducted a community-based longitudinal study.This study included 3,445 registered Japanese subjects (mean age 62.6 years), with a 7-year follow-up. Albuminuria was defined as a urine albumin-creatinine ratio (ACR) a parts per thousand yen30 mg/g in the morning spot urine.Subjects with albuminuria (n = 514, 14.9 %) were older and showed a higher prevalence of hypertension, obesity, and diabetes and lower values of estimated glomerular filtration rate (eGFR) than those without albuminuria (n = 2931, 85.1 %). During the follow-up, 138 subjects died. A Kaplan-Meier analysis showed that all-cause mortality significantly increased along with the increase in urine albumin excretion (log-rank test, P < 0.001). The subjects with albuminuria showed a significantly higher mortality rate than those without albuminuria (7.4 vs. 3.4 %; log-rank test, P < 0.001). A Cox proportional hazard model analysis after adjusting for possible confounders showed that albuminuria was an independent risk factor for all-cause and cardiovascular mortality (hazard ratio [HR] 1.69, 95 % confidence interval [CI] 1.12-2.56 and HR 2.27, 95 % CI 1.10-4.70, respectively) but not for noncardiovascular mortality. These associations were preserved after excluding subjects with high ACR (a parts per thousand yen300 mg/g).Albuminuria was a risk factor for all-cause and cardiovascular mortality in the Japanese population. To detect subjects with a high risk for premature death, measuring urinary albumin excretion might be useful.