| アブストラクト | INTRODUCTION: Changes in urinary albumin-to-creatinine ratio (UACR) may affect the risk of advanced chronic kidney disease (CKD). How much the association changes after taking account for natural variation in UACR and the length of time taken to observe changes in UACR is unknown. METHODS: English Clinical Practice Research Datalink records (2000-2015) with linkage to secondary care and death certification were used to identify prospective cohorts with at least 2 measures of UACR within 1, 2, and 3 years. Adjusted Cox regression assessed the separate relevance of the baseline UACR and the UACR change to the risk of developing stages 4 to 5 CKD and end-stage renal disease (ESRD). Associations were compared before and after accounting for the effects of the natural variation in UACR (i.e., regression to the mean). RESULTS: A total of 212,810 individuals had baseline UACR measurements; 22% had a UACR >/=3.4 mg/mmol, and 3% had UACR >/=33.9 mg/mmol. During a median 4-year follow-up, 5976 developed stage 4 to 5 CKD, and 1076 developed ESRD. There were strong associations between baseline UACR and stage 4 to 5 CKD or ESRD risk, which doubled in strength after accounting for regression to the mean. Over 3 years, the hazard ratios (95% confidence intervals) for stage 4 to 5 CKD, relative to stable UACR, were 0.62 (0.50-0.77) for at least a halving of UACR and 2.68 (2.29-3.14) for at least a doubling of UACR. Associations were weaker for shorter exposure windows (and for cardiovascular disease or death), but strengthened after allowing for regression to the mean. CONCLUSION: Baseline values and subsequent medium-term increases in albuminuria are both associated with substantially increased risk of developing advanced CKD. Standard analyses, not allowing for natural variation in UACR, may underestimate these associations. |
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| ジャーナル名 | Kidney international reports |
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| 投稿日 | 2018/7/11 |
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| 投稿者 | Smith, Margaret; Herrington, William G; Weldegiorgis, Misghina; Hobbs, Fd Richard; Bankhead, Clare; Woodward, Mark |
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| 組織名 | Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK.;Nuffield Department of Population Health, University of Oxford, Oxford, UK.;Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.;The George Institute for Global Health, University of Oxford, UK.;The George Institute for Global Health, University of New South Wales, Sydney,;Australia.;Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/29988998/ |
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