老年慢性肾脏病患者血清白蛋白水平与肾功能减退的关系
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摘要
目的探讨老年慢性肾脏病患者血清白蛋白水平对肾功能减退的影响。方法选取102例老年慢性肾脏病患者进行随访,测定血清白蛋白、血肌酐、血糖、估计肾小球滤过率(eGFR)及24h尿蛋白量等指标为基线资料;随访2年,根据eGFR变化,将患者分为无快速肾功能减退组(56例)和快速肾功能减退组(46例)。结果基线资料中,无快速肾功能减退组和快速肾功能减退组患者间的糖尿病比例、血清白蛋白及24 h尿蛋白量差异有统计学意义(均P<0.05);多因素Logistic回归分析显示,血清白蛋白水平越低(OR:0.274, 95%CI:0.146～0.514)、尿蛋白量越大(OR:1.025, 95%CI:1.013～1.037),老年慢性肾脏病患者出现肾功能减退的危险性越大。结论低蛋白血症和蛋白尿为老年慢性肾脏病患者肾功能减退的独立危险因素。
ObjectiveTo explore the correlation of serum albumin level to the decline of renal function of elderly patients with chronic kidney disease(CKD). Methods Firstly, 102 elderly patients of CKD were chosen as the subjects of study. Next, the subjects' serum albumin, creatinine, blood glucose, estimated glomerular filtration rate(eGFR) and 24 h urinary protein and so on were measured for baseline information. After two-year follow-ups, according to eGFR changes, the subjects were divided into two groups, namely, no rapid decline group(n=56) and rapid decline group(n=46). Results Baseline measurement analysis revealed that diabetes ratio, serum albumin and 24 h urinary protein levels were different between the two groups( P<0.05). Multivariate logistic regression analysis showed that the lower the level of serum albumin(OR: 0.274, 95%CI: 0.146～0.514), the higher the urine protein levels(OR: 1.025, 95%CI: 1.013～1.037), and hence the greater the risk of decline of renal function of elderly patients with CKD. Conclusions Hypoalbuminemia and proteinuria are the independent risk factors that contribute to the decline of renal function of elderly patients with CKD.
ObjectiveTo explore the correlation of serum albumin level to the decline of renal function of elderly patients with chronic kidney disease(CKD). Methods Firstly, 102 elderly patients of CKD were chosen as the subjects of study. Next, the subjects' serum albumin, creatinine, blood glucose, estimated glomerular filtration rate(eGFR) and 24 h urinary protein and so on were measured for baseline information. After two-year follow-ups, according to eGFR changes, the subjects were divided into two groups, namely, no rapid decline group(n=56) and rapid decline group(n=46). Results Baseline measurement analysis revealed that diabetes ratio, serum albumin and 24 h urinary protein levels were different between the two groups( P<0.05). Multivariate logistic regression analysis showed that the lower the level of serum albumin(OR: 0.274, 95%CI: 0.146～0.514), the higher the urine protein levels(OR: 1.025, 95%CI: 1.013～1.037), and hence the greater the risk of decline of renal function of elderly patients with CKD. Conclusions Hypoalbuminemia and proteinuria are the independent risk factors that contribute to the decline of renal function of elderly patients with CKD.
引文
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[14] ADVANCE Collaborative Group.Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J].N Engl J Med,2008,358(24):2560-2572.
[15] Sarnak MJ,Levey AS,Schoolwerth AC,et al.Kidney disease as a risk factor for development of cardiovascular disease:a statement from the American Heart Association Coucils on kidney in cardiovascular disease,high blood pressure research,clinical cardiology,and epidemiology and prevention[J].Hypertension,2003,42(5):1050-1065.
[2] Sampanis Ch.Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure[J].Hippokratia,2008,12(1):22-27.
[3] Rahman M,Xie D,Feldman HI,et al.Association between chronic kidney disease progression and cardiovascular disease:results from the CRIC Study[J].Am J Nephrol,2014,40(5):399-407.
[4] Lang J,Katz R,Ix JH,et al.Association of serum albumin levels with kidney function decline and incident chronic kidney disease in elders[J].Nephrol Dial Transplant,2018,33(6):986-992.
[5] Kikuchi H,Kanda E,Mandai S,et al.Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression:the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE)study[J].ClinExpNephrol,2017,21(1):55-62.
[6] Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[7] Go AS,Chertow GM,Fan D,et al.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization[J].N Engl J Med,2004,351(13):1296-1305.
[8] Chen SC,Chang JM,Tsai YC,et al.Left atrial diameter and albumin with renal outcomes in chronic kidney disease[J].Int J Med Sci,2013,10(5):575-584.
[9] de Zeeuw D,Remuzzi G,Parving HH,et al.Albuminuria,a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy[J].Circulation,2004,110(8):921-927.
[10] Gupta J,Mitra N,Kanetsky PA,et al.Association between albuminuria,kidney function,and inflammatory biomarker profile in CKD in CRIC[J].Clin J Am SocNephrol,2012,7(12):1938-1946.
[11] Trimarchi H,Muryan A,Dicugno M,et al.Proteinuria:an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis[J].Int J NephrolRenovasc Dis,2012,5:1-7.
[12] Stenvinkel P,Heimbürger O,Paultre F,et al.Strong association between malnutrition,inflammation,and atherosclerosis in chronic renal failure[J].Kidney Int,1999,55(5):1899-1911.
[13] Perkovic V,Heerspink HL,Chalmers J,et al.Intensive glucose control improves kidney outcomes in patients with type 2 diabetes[J].Kidney Int,2013,83(3):517-523.
[14] ADVANCE Collaborative Group.Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J].N Engl J Med,2008,358(24):2560-2572.
[15] Sarnak MJ,Levey AS,Schoolwerth AC,et al.Kidney disease as a risk factor for development of cardiovascular disease:a statement from the American Heart Association Coucils on kidney in cardiovascular disease,high blood pressure research,clinical cardiology,and epidemiology and prevention[J].Hypertension,2003,42(5):1050-1065.