eGFR和蛋白尿與實驗室異常指標之間的關系

Category: 生物國際競賽 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和蛋白尿與并發的實驗室異常指標之間的關系：一項全球性個體參與的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.

慢性腎臟病（CKD）較為復雜，歸因于腎臟小球濾過、小管及內分泌功能的破壞等異常情況。我們研究的目的是為了探索CKD不同階段特異性的實驗室結果異常、高血壓與eGFR、蛋白尿之間的關系。

Study Design 實驗設計

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

全球性個體參與水平橫斷面研究分析

Setting & Study Populations

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

17個CKD和38個一般人群和高風險的隊列

Selection Criteria for Studies 納入標準

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預后聯盟隊列中的eGFR和尿蛋白數據，以及血紅蛋白、碳酸氫鹽、磷、甲狀旁腺素、鉀、鈣和高血壓。

Data Extraction 數據提取

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

2015年7月-2018年1月間獲取數據和分析。

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.

我們使用線性回歸分析eGFR、蛋白尿與血紅蛋白、碳酸氫鹽、磷、甲狀旁腺素、鉀、鈣之間的關聯，使用logistic回歸分析與高血壓及各個絕對異常的指標之間的關聯。結果使用隨機效應的Meta分析合并。

Results 結果

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隊列共納入254,666例患者，27%為女性，10%為黑人，平均年齡69±12歲。一般人群/高風險隊列共納入1,758,334例研究對象，50%為女性，2%為黑人，平均年齡50±16歲。

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).

較低的eGFR與實驗室異常結果之間有強烈的等級關聯（將eGFR在15-29之間與45-50之間對比，OR值從3.27「95% CI, 2.68-3.97 」— 8.91「95% CI, 7.22-10.99」），然而蛋白尿與實驗室異常結果之間的關聯較為模糊或微弱（將尿蛋白/肌酐比在＞300與＜30mg/g之間對比，OR值從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.

研究時間、醫療系統、飲食類型、實驗室檢測之間的差異

Conclusions 結論

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.