High-normal albuminuria and risk of heart failure in the community.
High-normal albuminuria and risk of heart failure in the community.
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DOI：
10.1053/j.ajkd.2011.02.391
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发表时间：
2011-07
期刊：
影响因子：
--
通讯作者：
Coresh J
中科院分区：
文献类型：
--
作者：
Blecker S;Matsushita K;Köttgen A;Loehr LR;Bertoni AG;Boulware LE;Coresh J
白蛋白尿与心血管风险相关，但正常高值白蛋白尿与随后心力衰竭的关系尚未得到很好的确定。前瞻性观察性研究，社区动脉粥样硬化风险（ARIC）研究。从第四次ARIC研究访视（1996-1998）至2006年1月，对10，975名无心力衰竭的个体进行了随访。尿白蛋白-肌酐比（UACR），连续分类分析为最佳（<5 mg/g）、中等正常（5-9 mg/g）、高正常（10-29 mg/g）、微量白蛋白尿（30-299 mg/g）和大量白蛋白尿（≥300 mg/g）。心力衰竭事件定义为心力衰竭相关住院或死亡。校正年龄、种族、性别、估计肾小球滤过率（eGFR）和其他心血管危险因素后，采用考克斯比例风险模型计算心力衰竭的HR。个体随访中位数为8.3年，经历了344次心力衰竭事件。与正常UACR相比，白蛋白尿与心力衰竭风险从中度-正常（校正HR，1.54; 95% CI，1.12-2.11）和正常高值UACR（调整后的HR，1.91; 95%CI，1.38-2.66）至微量白蛋白尿（校正HR，2.49; 95% CI，1.77-3.50）和大量白蛋白尿（校正HR，3.47; 95% CI，2.10-5.72）。在冠心病事件发生时删失的参与者和沿着一系列eGFR的二次分析中，结果相似。UACR作为单个随机样品测量。白蛋白尿与随后的心力衰竭相关，即使在心血管危险因素很少且UACR在正常范围内的个体中也是如此。我们的研究结果表明，白蛋白尿和心力衰竭之间的关联可能不完全由缺血性心脏病或肾脏疾病介导，使用eGFR测量。
Albuminuria has been associated with cardiovascular risk, but the relationship of high-normal albuminuria to subsequent heart failure has not been well established. Prospective observational study, the Atherosclerosis Risk in Communities (ARIC) Study. 10,975 individuals free from heart failure were followed up from the fourth ARIC Study visit (1996–1998) through January 2006. Urinary albumin-creatinine ratio (UACR), analyzed continuously and categorically as optimal (<5 mg/g), intermediate-normal (5–9 mg/g), high-normal (10–29 mg/g), microalbuminuria (30–299 mg/g), and macroalbuminuria (≥300 mg/g). Incident heart failure was defined as a heart failure–related hospitalization or death. Cox proportional hazard models were used to calculate the HR of heart failure after adjustment for age, race, sex, estimated glomerular filtration rate (eGFR), and other cardiovascular risk factors. Individuals were followed up for a median of 8.3 years and experienced 344 heart failure events. Compared with normal UACR, albuminuria was associated with a progressively increased risk of heart failure from intermediate-normal (adjusted HR, 1.54; 95% CI, 1.12–2.11) and high-normal UACR (adjusted HR, 1.91; 95% CI, 1.38–2.66) to microalbuminuria (adjusted HR, 2.49; 95% CI, 1.77–3.50) and macroalbuminuria (adjusted HR, 3.47; 95% CI, 2.10–5.72). Results were similar in secondary analyses of participants censored at the time of coronary heart disease event and along a range of eGFRs. UACR was measured as a single random sample. Albuminuria is associated with subsequent heart failure, even in individuals with few cardiovascular risk factors and UACR within the normal range. Our results suggest that the association between albuminuria and heart failure may not be mediated fully by ischemic heart disease or kidney disease, measured using eGFR.
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