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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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ホモシステインと慢性腎臓病における死亡率との関連
Vandana Menon1, Mark J Sarnak, Tom Greene
1Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA.
Circulation
|March 22, 2006
まとめ
トータルホモシステイン (tHcy) レベルは,慢性腎臓病の3〜4段階の患者の死亡リスクを増加させるようには見えません. この研究では,tHcyの上昇と全因または心血管疾患による死亡率との関連は見つかりませんでした.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 心血管医学 心血管医学
- 臨床化学 臨床化学について
背景:
- 慢性腎臓病 (CKD) ステージ3〜4の患者における全ホモシステイン (tHcy) の予後値は,まだ十分に研究されていない.
- 増加したtHcyは,一般の人々の心血管疾患 (CVD) の既知の危険因子です.
研究 の 目的:
- CKD第3段階から第4段階の患者におけるtHcyレベルと死亡率との関連性を調査する.
- この患者グループにおいて,tHcyがあらゆる原因およびCVDによる死亡率の独立した危険因子であるかどうかを判断する.
主な方法:
- 腎臓疾患における食事の変更 (MDRD) 研究,ランダム化制御試験からのデータの分析.
- 血清tHcyは,CKDの第3〜第4段階の804人の患者でベースラインで測定されました.
- 全死因およびCVDの死亡率は,全国死亡指数を使用して10年間の追跡期間中位で評価されました.
主要な成果:
- 単変数分析では,tHcyの最高三位数と全因またはCVDの死亡率との間に有意な関連性が見つかりませんでした.
- 推定グルメルフィルタレーション率 (eGFR) を調整すると,観測された関連性はさらに弱まった.
- tHcyは連続変数として分析され,全因またはCVD死亡率との関連性も示されなかった.
結論:
- ハイパーホモシステインエミアは,CKDのステージ3〜4の患者において,全因またはCVDの死亡率の有意な危険因子であるようには見えません.
- 以前の研究では,腎臓機能への調整が不十分であるため,tHcyとCVDリスクの関連性を過大評価していた可能性があります.
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