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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2814

摘要内容如下：

背景

蛋白尿是慢性肾脏病（CKD）进展的主要危险因素，尤其是当分类为中度（30至300 mg/G）或重度（>300 mg/G）时。然而，在CKD患者中，正常白蛋白尿范围（<30 mg/G）内的白蛋白尿的预后价值数据有限。

客观

评估在蛋白尿正常（<30 mg/G）的CKD患者中，随着蛋白尿基线水平升高，CKD进展的累积发生率增加。

设计

多中心前瞻性队列研究。

设置

7个美国临床中心。

参与者

1629名符合CRIC（慢性肾功能不全队列）研究标准的CKD（估计肾小球滤过率[EGFR]，20至70 mL/min/1.73 m2）和尿白蛋白-肌酐比值（UACR）低于30 mg/G的参与者。

测量

基线点尿白蛋白除以点尿肌酐，计算UACR作为暴露变量。使用G-公式从混杂因素校正的生存曲线中得出的CKD进展（EGFR下降50%或肾功能衰竭[透析或肾移植]的复合因素）的10年校正累积发生率。

结果

在中位数为9.8年的随访中，1629名参与者中有182名出现CKD进展。UACR水平为0至低于5 mg/G、5至低于15 mg/G和15 mg/G或更高时，CKD进展的10年校正累积发生率分别为8.7%（95%CI，5.9%至11.6%）、11.5%（CI，8.8%至14.3%）和19.5%（CI，15.4%至23.5%）。将UACR为15 mg/G或以上的人与UACR为5至低于15 mg/G和0至低于5 mg/G的人相比，绝对风险差异分别为7.9%（CI，3.0%至12.7%）和10.7%（CI，5.8%至15.6%）。基于基线UACR水平，10年校正累积发病率呈线性增加。

局限性

测量一次UACR。

结论

患有CKD和正常白蛋白尿（<30 mg/G）的患者发生CKD进展的风险更高，且随着白蛋白尿水平的升高而呈线性增加。

主要资金来源

没有。

英文原文如下：

Abstracts

BACKGROUND  Albuminuria is a major risk factor for chronic kidney disease (CKD) progression, especially when categorized as moderate (30 to 300 mg/g) or severe (>300 mg/g). However, there are limited data on the prognostic value of albuminuria within the normoalbuminuric range (<30 mg/g) in persons with CKD.

OBJECTIVE  To estimate the increase in the cumulative incidence of CKD progression with greater baseline levels of albuminuria among persons with CKD who had normoalbuminuria (<30 mg/g).

DESIGN  Multicenter prospective cohort study.

SETTING  7 U.S. clinical centers.

PARTICIPANTS  1629 participants meeting criteria from the CRIC (Chronic Renal Insufficiency Cohort) study with CKD (estimated glomerular filtration rate [eGFR], 20 to 70 mL/min/1.73 m2) and urine albumin-creatinine ratio (UACR) less than 30 mg/g.

MEASUREMENTS  Baseline spot urine albumin divided by spot urine creatinine to calculate UACR as the exposure variable. The 10-year adjusted cumulative incidences of CKD progression (composite of 50% eGFR decline or kidney failure [dialysis or kidney transplantation]) from confounder adjusted survival curves using the G-formula.

RESULTS  Over a median follow-up of 9.8 years, 182 of 1629 participants experienced CKD progression. The 10-year adjusted cumulative incidences of CKD progression were 8.7% (95% CI, 5.9% to 11.6%), 11.5% (CI, 8.8% to 14.3%), and 19.5% (CI, 15.4% to 23.5%) for UACR levels of 0 to less than 5 mg/g, 5 to less than 15 mg/g, and 15 mg/g or more, respectively. Comparing persons with UACR 15 mg/g or more to those with UACR 5 to less than 15 mg/g and 0 to less than 5 mg/g, the absolute risk differences were 7.9% (CI, 3.0% to 12.7%) and 10.7% (CI, 5.8% to 15.6%), respectively. The 10-year adjusted cumulative incidence increased linearly based on baseline UACR levels.

LIMITATION  UACR was measured once.

CONCLUSION  Persons with CKD and normoalbuminuria (<30 mg/g) had excess risk for CKD progression, which increased in a linear fashion with higher levels of albuminuria.

PRIMARY FUNDING SOURCE  None.

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