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推定グルメルフィルタレーション率,アルブミヌリア,および有害な結果:個々の参加者のデータメタ解析

, Morgan E Grams ^1,2, Josef Coresh ²

¹Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York.
²Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
³Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France.
⁴School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
⁵School of Health and Social Studies, Dalarna University, Falun, Sweden.
⁶Department of Neurobiology, Care Sciences, and Society, Family Medicine and Primary Care Unit, Karolinska Institutet, Huddinge, Sweden.
⁷Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸Division of Nephrology, University of Washington, Seattle.
⁹Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland.
¹⁰Diabetes Centre and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
¹¹Department of Cardiovascular Sciences, University of Leicester, and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, England.
¹²Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.
¹³Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
¹⁴George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹⁵School of Public Health, Imperial College, London, England.
¹⁶Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹⁷Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana.
¹⁸AMGA (American Medical Group Association), Alexandria, Virginia.
¹⁹Department Scuola Medica Salernitana, University of Salerno, Fisciano, Italy.
²⁰Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
²¹Department of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
²²Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
²³Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
²⁴Division of Nephrology, Endocrinology, and Metabolism, School of Medicine, Tokai University, Isehara, Japan.
²⁵Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania.
²⁶Center for Kidney Health Research, Geisinger, Danville, Pennsylvania.
²⁷Division of Nephrology, University of Alabama at Birmingham.
²⁸Medical Research Council Population Health Research Unit, University of Oxford, Oxford, England.
²⁹Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, England.
³⁰Framingham Heart Study, Framingham, Massachusetts.
³¹Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
³²Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
³³Okinawa Heart and Renal Association, Okinawa, Japan.
³⁴Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
³⁵Duke Global Health Institute, Duke University, Durham, North Carolina.
³⁶University of California-San Diego, La Jolla.
³⁷San Diego VA Health Care System, San Diego, California.
³⁸George Institute for Global Health India, New Delhi, India.
³⁹George Institute for Global Health, School of Public Health, Imperial College, London, England.
⁴⁰Department of Public Health, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan.
⁴¹Department of Obstetrics and Gynecology, University of Washington, Seattle.
⁴²Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
⁴³Department of Public Health and Hygiene, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁴⁴Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
⁴⁵Kaiser Permanente, Hawaii Region, and Moanalua Medical Center, Honolulu, Hawai'i.
⁴⁶School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland.
⁴⁷Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland.
⁴⁸Division of Nephrology, University of British Columbia, Vancouver, Canada.
⁴⁹Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona.
⁵⁰Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel.
⁵¹Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan.
⁵²Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁵³Service de Néphrologie Dialyse Aphérèse, Nîmes Hôpital Universitaire, Nîmes, France.
⁵⁴IDESP, UMR-INSERM, Universite de Montpellier, Montpellier, France.
⁵⁵Public Health, Osaka University Graduate School of Medicine, Suita, Japan.
⁵⁶Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵⁷London School of Hygiene and Tropical Medicine, London, England.
⁵⁸Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
⁵⁹Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁶⁰Division of Transplantation, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
⁶¹Center for Health Equity, Johns Hopkins University, Baltimore, Maryland.
⁶²Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
⁶³Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.
⁶⁴Division of Public Health, Hygiene, and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
⁶⁵Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, Scotland.
⁶⁶NHS Grampian, Aberdeen, Scotland.
⁶⁷Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
⁶⁸Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
⁶⁹Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California.
⁷⁰Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco.
⁷¹General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.
⁷²Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, England.
⁷³Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
⁷⁴Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷⁵Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida, IRBLleida and University of Lleida, Lleida, Spain.
⁷⁶Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
⁷⁷Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁷⁸Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
⁷⁹Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan/China Medical University Hospital, Taichung, Taiwan.
⁸⁰Department of Renal Medicine, University College London, London, England.
⁸¹Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁸²Department of Nephrology, University of Tsukuba, Tsukuba, Japan.
⁸³Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
⁸⁴Division of Nephrology, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
⁸⁵ICES Western, London, Ontario, Canada.
⁸⁶National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
⁸⁷Peking University First Hospital, Beijing, China.
⁸⁸Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

⁰Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York.

Jama +

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2023年10月3日

PubMedで要約を見る

まとめ

推定グルメルフィルタレーション率 (eGFR) の低下とアルブミヌリアの上昇は,腎臓疾患,心血管疾患,入院のリスクの増加と関連しています. これらの発見は,軽度の慢性腎臓病でも腎臓機能のモニタリングの重要性を強調しています.

科学分野

腎臓科
心血管医学
流行病学について

背景

慢性腎疾患 (CKD) は,米国の成人の14%に影響し,低推定グルメルフィルタレーション率 (eGFR) またはアルブミヌリアによって特徴付けられています.
早期発見とリスク評価は,CKDとその合併症の管理に不可欠です.

研究の目的

低GFR (クレアチニン単独またはシスタチンCと併用) と高アルブミヌリアと腎臓および心血管の不良結果との関連を評価する.
すべての原因による死亡率と入院率を含む他の健康上の結果のリスクを評価する.

主な方法

114のグローバルコホート (eGFRによるクレアチニン) と20のコホート (eGFRによるクレアチニンとシスタチンC) の2700万人を対象とした個人参加者データメタ解析.
アルブミヌリアは,尿中のアルブミン対クレアチニン比率 (UACR) を用いて評価された.
ランダム効果メタアナリシスは,腎不全,死亡率,心血管疾患,入院のリスクを要約するために使用されました.

主要な成果

EGFRの低下とUACRの上昇は,研究されたすべての10の有害な結果のリスクの増加と有意に関連していました.
軽度のCKDカテゴリーでさえ,著しく高いリスクを示した.例えば,eGFRのレベルが45-59mL/min/1.73m2であった場合,eGFRのレベルが高い場合と比較して,より高い入院率と関連していた.
関連性は,異なるeGFR推定方法とアルブミヌリアレベルにおいて一貫していました.

結論

EGFRの低下とUACRの上昇は,腎臓の不良の結果,心血管疾患,入院の実質的に高いリスクと関連しています.
これらの発見は,軽度の腎機能低下またはアルブミヌリアを有する個体でも,CKDのスクリーニングとリスクの階層化の重要性を強調しています.
この研究は,eGFRとUACRの両方の長期的な健康結果の予測価値を強調しています.

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