eGFR和蛋白尿与实验室异常指标之间的关系

Category: 生物国际竞赛 Date: 2019年1月30日下午3:10

Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium

eGFR和蛋白尿与并发的实验室异常指标之间的关系：一项全球性个体参与的Meta分析

Abstract

Rationale & Objective 研究背景

Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework.

慢性肾脏病（CKD）较为复杂，归因于肾脏小球滤过、小管及内分泌功能的破坏等异常情况。我们研究的目的是为了探索CKD不同阶段特异性的实验室结果异常、高血压与eGFR、蛋白尿之间的关系。

Study Design 实验设计

Cross-sectional individual participant-level analyses in a global consortium.

全球性个体参与水平横断面研究分析

Setting & Study Populations

17 CKD and 38 general population and high-risk cohorts.

17个CKD和38个一般人群和高风险的队列

Selection Criteria for Studies 纳入标准

Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension.

CKD预后联盟队列中的eGFR和尿蛋白数据，以及血红蛋白、碳酸氢盐、磷、甲状旁腺素、钾、钙和高血压。

Data Extraction 数据提取

Data were obtained and analyzed between July 2015 and January 2018.

2015年7月-2018年1月间获取数据和分析。

Analytical Approach 分析方法

We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses.

我们使用线性回归分析eGFR、蛋白尿与血红蛋白、碳酸氢盐、磷、甲状旁腺素、钾、钙之间的关联，使用logistic回归分析与高血压及各个绝对异常的指标之间的关联。结果使用随机效应的Meta分析合并。

Results 结果

The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years.

CKD队列共纳入254,666例患者，27%为女性，10%为黑人，平均年龄69±12岁。一般人群/高风险队列共纳入1,758,334例研究对象，50%为女性，2%为黑人，平均年龄50±16岁。

There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 95% CI, 2.68-3.97 to 8.91 95% CI, 7.22-10.99comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 95% CI, 0.60-0.99 to 1.92 95% CI, 1.65-2.24 comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g).

较低的eGFR与实验室异常结果之间有强烈的等级关联（将eGFR在15-29之间与45-50之间对比，OR值从3.27「95% CI, 2.68-3.97 」— 8.91「95% CI, 7.22-10.99」），然而蛋白尿与实验室异常结果之间的关联较为模糊或微弱（将尿蛋白/肌酐比在＞300与＜30mg/g之间对比，OR值从0.77「95% CI, 0.60-0.99 」— 1.92「95% CI, 1.65-2.24」）。

Limitations局限性

Variations in study era, health care delivery system, typical diet, and laboratory assays.

研究时间、医疗系统、饮食类型、实验室检测之间的差异

Conclusions 结论

Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.