Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts.
Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts.
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DOI：
10.1038/ki.2010.531
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发表时间：
2011-07
影响因子：
19.6
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中科院分区：
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低 eGFR 和白蛋白尿都是 ESRD 的已知危险因素。本文重点关注它们对 ESRD 和其他肾脏结局的共同贡献。我们对 9 个一般人群队列（包含 845,125 名参与者）和 8 个队列（包含 173,892 名参与者）进行了协作荟萃分析，因为慢性肾病的高风险被选中。 eGFR 和蛋白尿均被检测为 ESRD、急性肾损伤和进行性慢性肾病的危险因素。在一般人群中，ESRD 风险与 eGFR 值（75-105 ml/min/1.73m2）无关，并且在 eGFR 较低时呈指数增加。调整白蛋白肌酐比和心血管风险后，eGFR 60、45 和 15（与 95）ml/min/1.73m2 时的风险比（95% 置信区间）分别为 3.69 (2.36–5.76)、29.3 (19.5–44.1) 和 454.9 (112.4–1840.2)因素。蛋白尿与 ESRD 风险呈线性相关，无阈值。白蛋白与肌酐比率为 30、300 和 1000（与 5）mg/g 时的调整后风险比分别为 4.87（2.30-10.3）、13.4（5.49-32.7）和 28.4（14.9-54.2）。 eGFR 和蛋白尿与 ESRD 成倍相关，但没有相互作用的证据。急性肾损伤和进行性慢性肾病之间也观察到类似但数量上不太明显的关联。高风险人群中的研究结果通常与一般人群中的结果相当。总之，在普通人群和高危人群中，较低的 eGFR 和较高的蛋白尿是 ESRD、急性肾损伤和进行性慢性肾病的危险因素，且彼此独立且与心血管危险因素无关。
Both low eGFR and albuminuria are known risk factors for ESRD. This paper focuses on their joint contribution to ESRD and other kidney outcomes. We performed a collaborative meta-analysis of 9 general population cohorts with 845,125 participants and 8 cohorts with 173,892 participants selected because of high risk for chronic kidney disease. Both eGFR and albuminuria were tested as risk factors for ESRD, acute kidney injury and progressive chronic kidney disease. In general population cohorts, the risk for ESRD was unrelated to eGFR at values 75–105 ml/min/1.73m2 and increased exponentially at lower eGFR. Hazard ratios (95% confidence interval) at eGFR 60, 45, and 15 (versus 95) ml/min/1.73m2 were 3.69 (2.36–5.76), 29.3 (19.5–44.1) and 454.9 (112.4–1840.2), respectively, after adjustment for albumin-to-creatinine ratio and cardiovascular risk factors. Albuminuria was associated with ESRD risk linearly without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios 30, 300 and 1000 (versus 5) mg/g were 4.87 (2.30–10.3), 13.4 (5.49–32.7) and 28.4 (14.9–54.2), respectively. eGFR and albuminuria were multiplicatively associated with ESRD, without evidence for interaction. Similar, but numerically less pronounced associations were observed for acute kidney injury and progressive chronic kidney disease. The findings in high risk cohorts were generally comparable to those in general population cohorts. In conclusion, lower eGFR and higher albuminuria are risk factors for ESRD, acute kidney injury and progressive chronic kidney disease independent of each other and of cardiovascular risk factors, both in the general population and high risk cohorts.