肾功能减退、微量白蛋白尿均增加心血管死亡风险

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Reduced kidney function, microalbuminuria increase CV death risk

13 December 2007

MedWire News: Patients with reduced kidney function and microalbuminuria are at high risk for cardiovascular (CV) death, study findings indicate.

The authors suggest that inclusion of the combined variable of estimated glomerular filtration rate estimated GFR and albumin-creatinine ratio (ACR) could improve risk stratification in general, and in particular among elderly persons, for whom traditional risk factors have reduced predictive power.

Most studies have examined the association between cardiovascular disease (CVD) and either microalbuminuria or estimated GFR, but not both, Stein Hallan (Norwegian University of Science and Technology, Trondheim, Norway) and colleagues explain.

They explored the association among abnormal estimated GFR, albuminuria, and cardiovascular mortality in 9709 patients participating in the second Nord-Tr鴑delag Health Study (HUNT II).

The estimated GFR was calculated from calibrated serum creatinine, and the urine albumin-creatinine ratio (ACR) was measured in three urine samples.

During a mean follow-up period of 8.3 years, 1018 patients died of CVD.

Patients with estimated GFR lower than 75 ml/min/1.73m2 were more likely to die of CVD than those with higher estimated GFR. The incidence rate ratio (IRR) for CV death increased continuously with increasing ACR.

In particular, patients with estimated GFR lower than 45 ml/min/1.73m2 and microalbuminuria had an age- and gender-adjusted IRR for CV death of 6.7 (p<0.001), compared with patients with estimated GFR greater than 75 ml/min/1.73m2 and ACR below the gender-specific median.

This increased CV mortality risk remained significant after adjusting for prevalent CVD, diabetes mellitus, systolic blood pressure, antihypertensive medication, smoking, and cholesterol level (IRR=5.94).

Age-stratified analyses in this patient group revealed that CV death was significantly more likely in those aged 70 years or older than in patients younger than 70 years (63.6 versus 4.1 cardiovascular deaths per 1000 person-years).

Hallan et al conclude in the Archives of Internal Medicine: \"Reduced kidney function and microalbuminuria are risk factors for cardiovascular death, independent of each other and traditional risk factors.\"

Arch Intern Med 2007; 167: 2490-2496
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