2型糖尿病患者尿蛋白水平与血清白细胞介素1β和晚期蛋白氧化产物的关系

目的观察不同尿白蛋白排泄率（UAER）的2型糖尿病患者血清白细胞介素18（IL-1β）和晚期蛋白氧化产物（AOPP）水平,探讨其在糖尿病蛋白尿发生和发展中的作用。方法选择2008年11月至2010年2月在我院住院的2型糖尿病患者62例,按照UAER水平分组：间断白蛋白尿组（n=20）,UAER〈20μg／min;微量白蛋白尿组（n=22）,UAER20-200μg／min;临床白蛋白尿组（n=20）,UAER〉200μg／min。选择同期健康体检者20例作为对照组。比较各组血清IL-1μ和AOPP水平。结果3组糖尿病患者血清IL-1β和AOPP水平均高于对照组（P〈0．05）,微量白蛋白尿组IL-1β和AOPP水平均高于正常白蛋白尿组（P〈0．05）,显性白蛋白尿组IL-1β和AOPP水平均高于微量白蛋白尿组和正常白蛋白尿组（P〈0．01）。血清IL-1β与AOPP呈正相关（r=0．760,P〈0．01）,血清IL-1β和AOPP与UAER呈正相关（r分别为0．809和0．813,P〈0．01）。结论IL-1β和AOPP可作为糖尿病肾脏微血管病变的早期预测因子,对预防糖尿病肾脏微血管病变有重要意义。     

糖尿病肾脏疾病不同尿白蛋白分期相关影响因素的分类树模型分析

目的:分析2型糖尿病出现微量白蛋白尿和大量白蛋白尿的相关影响因素,筛查糖尿病肾脏疾病(DKD)高风险人群。方法:收集本院2008年~2015年的1 176例2型糖尿病临床资料,据尿白蛋白水平分为无白蛋白尿组(729例)、微量白蛋白尿组(274例)和大量白蛋白尿组(173例)。使用分类树模型进行不同蛋白尿分期相关影响因素分析,通过节点增益分析筛选微量和大量白蛋白尿的高风险人群。结果:建立的分类树模型共包括5层,31个节点,从27个预测变量中筛选到5个重要解释变量:Cys C、Fib、收缩压、糖尿病视网膜病变、糖尿病病程;CysC水平是DKD重要的影响因素。结论:分类树模型能有效筛选并分析不同白蛋白尿水平相关影响因素,并识别高风险人群特征,有利于早期防治。     

视网膜血管直径与高血压、白蛋白尿的关系探讨

目的视网膜血管是活体状态下唯一可通过无创方式观察到的血管,其病变可能会反映肾脏血管病变,而微循环系统的异常又可影响到体循环血压的变化。本文将针对这三者之间的关系进行研究。方法采用横断面研究,入组5 541人,测量尿白蛋白/尿肌酐、视网膜中央动脉直径、视网膜中央静脉直径及血压等指标;应用SPSS 17. 0计算相关性。结果视网膜动脉直径最小组白蛋白尿发生风险是最大组的1. 24倍(95%CI 1. 02～1. 51),视网膜静脉直径变化与白蛋白尿的发生无相关性。在经多因素调整后,高血压病人群整体发生白蛋白尿的风险较高,是对照组的1. 41倍(95%CI 1. 21～1. 64)。视网膜动脉狭窄合并高血压病时,发生白蛋白尿的风险最高,是对照组的1. 69倍(95%CI 1. 31～2. 19)。结论视网膜动脉狭窄与白蛋白尿发生独立相关,视网膜静脉直径变化与白蛋白尿发生无明显相关性。高血压病人群整体发生白蛋白尿的风险升高,且当合并视网膜动脉狭窄时,白蛋白尿发生率最高。提示视网膜血管检查与蛋白尿的检查及血压监测应结合起来,可能成为临床筛查慢性肾脏病的更有效方法。     

尿8-OHdG检测在糖尿病肾病患者中的临床价值

目的：通过检测糖尿病肾病（DN）患者尿中DNA氧化损伤的主要的标记物8-羟基脱氧鸟苷（8-OHdG）,评价2型糖尿病患者早期肾脏病变与氧化应激的关系并探讨其临床意义。方法：选取DN患者90例,分为正常蛋白尿组,微量蛋白尿组、大量蛋白尿组各30例,检测尿8-OHdG,尿微量白蛋白、NAG等指标。结果：糖尿病组的尿8-OHdG水平显著高于正常对照组[（16.5±0.3） vs （10.8±0.5）ng/mg Cr,P〈0.01];微量蛋白尿组和大量蛋白尿组的尿8-OHdG水平明显高于正常蛋白尿组（P〈0.01）,大量蛋白尿组的尿8-OHdG水平显著高于微量蛋白尿组（P〈0.01）。 DN患者尿8-OHdG水平与总胆固醇、低密度脂蛋白呈正相关,与BMI及eGFR呈负相关。尿8-OHdG水平与尿微量白蛋白、尿NAG、α2-MG、FDP呈显著正相关。结论：DN 患者随着蛋白尿的增多及肾功能的进展其氧化应激水平增强,氧化应激的重要标志物8-OHdG作为重要因素参与DN的发生与发展。     

白蛋白尿与高血压患者血压水平的关系

目的 研究我国不同区域高血压患者白蛋白尿与血压水平及体质量指数（BMI）的关系。 方法 在我国5个城市随机抽取5021例明确诊断为高血压的非糖尿病患者,进行两次随机点测尿中的白蛋白/肌酐比值,将尿蛋白的检出率与不同血压水平及BMI进行统计分析。 结果 （1）高血压患者白蛋白尿的检出率,在< 60岁与≥60岁组间差异无统计学意义;高血压病程越长,其检出率越高（P < 0.05）。（2）白蛋白尿检出率与血压水平相关,血压越高,尿蛋白量越高。正常血压、正常高值以及Ⅰ、Ⅱ、Ⅲ级高血压的白蛋白尿检出率分别为26.3%、27.3%、28.7%、31.5%和40.3%。（3）高血压患者血压控制达标（<140/90 mm Hg）与控制不良（≥140/90 mm Hg）的蛋白尿排出率差异有统计学意义（27.1% 比 30.2%,P < 0.05）。（4）同等血压水平时,肥胖高血压患者的白蛋白尿检出率高于体质量正常者,但差异无统计学意义。（5）有蛋白尿的高血压患者发生更多的心脑肾血管事件。 结论 我国5021例高血压患者中,其白蛋白尿的发生率为28.8%,其中微量白蛋白尿的发生率为18.6%,临床白蛋白尿的发生率为10.2%。血压控制不良是蛋白尿发生的重要因素。     

高同型半胱氨酸与糖尿病肾病患者血胱抑素C相关性研究

目的观察血浆同型半胱氨酸(Hcy)与血清胱抑素C(Cystatin C)在糖尿病肾病不同尿微量白蛋白排泄率时的改变及其相关性.方法根据24 h尿微量白蛋白排泄率(UAER)将60例2型糖尿病患者分为3组正常白蛋白尿组(18例)、微量白蛋白尿组(25例)、大量蛋白尿组(17例),同时以20例健康人作为正常对照组.分别检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、胆固醇(TC)、血肌酐(Scr)、Hcy、Cystatin C水平,双变量相关分析采用直线相关分析.结果糖尿病肾病患者正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组Hcy测值(分别为8.40±2.56,9.12±2.01,13.3±4.96)高于正常对照组(6.91±0.37),且组间比较均有统计学差异(P＜0.01);糖尿病肾病患者各组间正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组Cystatin C测值组间比较均有统计学差异(分别为0.63±0.19、0.88±0.35、1.68±0.89,P＜0.01);随着尿微量白蛋白排泄的增加、肾小球滤过功能受损的加重,Hcy与Cystatin C水平均有一增长趋势,且两指标呈正相关(正常白蛋白尿组r＝0.632,微量白蛋白尿组r＝0.873,大量蛋白尿组r＝0.747,P＜0.01).结论联合检测同型半胱氨酸与胱抑素C可推断同型半胱氨酸对肾小球滤过功能的影响,推断糖尿病肾损害的程度,更全面的评价早期糖尿病肾损害,提示临床应早期干预血同型半胱氨酸水平.     

联合检测尿转铁蛋白、α1-微球蛋白和血Cystatin C对糖尿病肾病早期诊断价值

目的：探讨联合检测尿转铁蛋白（TRF）、α1-微球蛋白（α1-MG）和血半胱氨酸蛋白酶抑制剂C（Cystatin C）对糖尿病肾病（DN）早期诊断的临床意义。方法：64例2型糖尿病患者根据尿白蛋白排泄率（UAER）分为3组,A组为正常白蛋白尿组（UAER≤20μg/min）22例,B组为微量白蛋白尿组（UAER 20～200μg/min）19例;C组为大量白蛋白尿组（UAER≥200μg/min）23例。收集并测定各组患者24 h尿微量白蛋白、TRF、α1-MG,同时检测血清肌酐及Cystatin C,比较各组患者指标的变化。结果：与A组相比,B组和C组TRF、α1-MG和血Cystatin C均显著增高,联合检测阳性率明显高于单项检测。结论：联合检测TRF、α1-MG和血Cystatin C可以反应DN的早期损害,有利于早期诊断。     

2型糖尿病患者血清胆红素水平与糖尿病肾病的相关性

目的:探讨2型糖尿病患者血清胆红素水平与糖尿病肾病的相关性。方法:156例2型糖尿病患者,按照尿白蛋白排泄率水平分为正常蛋白尿组(n=54),微量蛋白尿组(n=50),大量蛋白尿组(n=52),比较患者一般资料及胆红素水平并进行分析。结果:三组间的总胆红素水平和直接胆红素水平,大量蛋白尿组微量蛋白尿组正常蛋白尿组,差异有统计学意义(P0.01)。Pearson相关分析表明,血清总胆红素与尿白蛋白排泄率呈负相关(r=-0.305,P0.01)。Logistic回归分析显示,总胆红素是糖尿病肾病的独立保护性因素(OR=0.832,95%CI:0.725~0.954,P0.01)。结论:总胆红素水平与尿白蛋白排泄率水平相关,胆红素的下降参与了糖尿病肾病的发生、发展。     

2型糖尿病患者不同蛋白尿期肾小球滤过率的变化及影响因素

目的 研究2型糖尿病（DM）患者不同蛋白尿期的肾小球滤过率并探讨其影响因素。 方法 根据尿白蛋白量（24 h）把630例2型糖尿病住院患者分成正常白蛋白尿组（A组）、微量白蛋白尿组（B组）及大量白蛋白尿组（C组），用放射性核素(99m Tc-DTPA)肾动态显像测定肾小球滤过率(GFR), 同时测定其体质量指数、血压、血糖、糖化血红蛋白、肾功能、血脂及尿白蛋白量（24 h）。 结果 （1）A组GFR值平均为（99.8±26.3） ml/min；B组为（96.1±31.2） ml/min；C组为（69.7±29.8） ml/min。C组的GFR显著低于A组和B组（P < 0.01）。（2）3组患者的GFR均与年龄呈负相关（A组r = -0.533，B组r = -0.612，C组r = -0.412，均P < 0.01）。（3）有高血压史者的GFR平均值均低于同组无高血压史者（P均< 0.05）。（4）控制年龄后的偏相关分析结果显示，在B组及C组，GFR与尿白蛋白量（24 h）呈负相关（r = -0.283 及-0.240，均P < 0.05）。多元逐步回归分析结果显示，尿白蛋白量（24 h）是影响异常蛋白尿组患者GFR的主要因素。 结论 放射性核素肾动态显像法测定GFR，同时联合尿白蛋白量检测，能更全面准确地评估糖尿病肾病的进展。应积极控制蛋白尿，尤其在微量白蛋白尿期。     

2型糖尿病患者微量白蛋白尿与骨密度的关系

目的 研究2型糖尿病患者微量白蛋白尿与骨密度的关系.方法 正常对照组55例,2型楮尿病患者86例.糖尿病患者根据尿白蛋白排泄率(UAE)分成正常白蛋白尿组及微量白蛋白尿组.使用双能X线骨密度测量仪测量左前臂、左髋部及腰椎的骨密度(BMD).结果 女性2型糖尿病微量白蛋白尿组各部位BMD较正常白蛋白尿组差异无显著性(P>0.05),但腰椎BMD较无糖尿病组增高(P<0.05).男性2型糖尿病微量白蛋白尿组各部位BMD较另两组男性差异无显著性(P>0.05).结论 2型糖尿病伴微量白蛋白尿的患者无明显骨量减少或骨质疏松.     

Renal transplant dysfunction--importance quantified in comparison with traditional risk factors for cardiovascular disease and mortality.

BACKGROUND: Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial. METHODS: All patients were on cyclosporine-based immunosuppressive therapy, follow-up was 5-6 years and captured endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke. RESULTS: A calculated 84 micromol/l increase in serum creatinine was needed to double the risk for cardiac death, an increase of 104 micromol/l to double the risk for non-cardiovascular death and an increase of 92 micromol/l to double the risk for all-cause mortality. MACE risk was doubled if serum creatinine was elevated by 141 micromol/l, age was increased by 23 years, or LDL-cholesterol by 2 mmol/l. Diabetes increased the incidences of cardiac death, all-cause mortality, MACE, stroke and non-fatal MI. A serum creatinine increase of approximately 130 micromol/l, or approximately 20 years increase in age was calculated as similar in risk for cardiac death, all-cause mortality and MACE, and comparable to risk of diabetes in RTR. CONCLUSION: An increase in serum creatinine of 80-100 micromol/l doubles the risk for cardiac death, non-cardiovascular death and all-cause mortality in RTR. An increase of 130 micromol/l in serum creatinine or approximately 20 years increase in age is comparable to risk of diabetes.     

Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes

In patients with ESRD, the effects of online hemodiafiltration on all-cause mortality and cardiovascular events are unclear. In this prospective study, we randomly assigned 714 chronic hemodialysis patients to online postdilution hemodiafiltration (n=358) or to continue low-flux hemodialysis (n=356). The primary outcome measure was all-cause mortality. The main secondary endpoint was a composite of major cardiovascular events, including death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, therapeutic coronary intervention, therapeutic carotid intervention, vascular intervention, or amputation. After a mean 3.0 years of follow-up (range, 0.4-6.6 years), we did not detect a significant difference between treatment groups with regard to all-cause mortality (121 versus 127 deaths per 1000 person-years in the online hemodiafiltration and low-flux hemodialysis groups, respectively; hazard ratio, 0.95; 95% confidence interval, 0.75-1.20). The incidences of cardiovascular events were 127 and 116 per 1000 person-years, respectively (hazard ratio, 1.07; 95% confidence interval, 0.83-1.39). Receiving high-volume hemodiafiltration during the trial associated with lower all-cause mortality, a finding that persisted after adjusting for potential confounders and dialysis facility. In conclusion, this trial did not detect a beneficial effect of hemodiafiltration on all-cause mortality and cardiovascular events compared with low-flux hemodialysis. On-treatment analysis suggests the possibility of a survival benefit among patients who receive high-volume hemodiafiltration, although this subgroup finding requires confirmation.     

Correlation of uric acid and urinary albumin excretion rate in patients with type 2 diabetes mellitus in Taiwan

BACKGROUND: Uric acid is detrimental to the kidneys in animal models. However, its role in human diabetic nephropathy has not been extensively studied. This study evaluated the association between serum uric acid and urinary albumin-to-creatinine ratio (ACR) among patients with type 2 diabetes mellitus in Taiwan. METHODS: A total of 343 patients (144 men and 199 women), aged 62.8 +/- 10.8 years and not using uric acid-lowering agents, diuretics, or alcohol, were recruited. Serum uric acid and urinary ACR were determined. Normoalbuminuria, microalbuminuria, and macroalbuminuria were defined as ACR <30.0, 30.0 to 299.9, and > or =300.0 microg/mg, respectively. RESULTS: The respective uric acid levels for normoalbuminuria (N= 166), microalbuminuria (N= 130), and macroalbuminuria (N= 47) were 5.2 +/- 1.6 mg/dL, 5.6 +/- 1.9 mg/dL, and 6.7 +/- 2.1 mg/dL (P < 0.001). The mean +/- SD (minimum-maximum) values of uric acid for the first to the fourth quartile were 3.4 +/- 0.6 (1.7-4.2), 4.9 +/- 0.4 (4.3-5.4), 6.0 +/- 0.3 (5.5-6.5), and 8.1 +/- 1.2 (6.6-12.2), respectively. Prevalence of abnormal albuminuria (microalbuminuria plus macroalbuminuria) for the respective quartiles were 38.4%, 51.2%, 50.6%, and 66.3% (P trend <0.01). In men, uric acid correlated positively with triglycerides and natural logarithmic [ln (ACR)] (gamma= 0.168, P < 0.05). In women, uric acid correlated positively with triglycerides, ln (ACR) (gamma= 0.277, P < 0.01) and body mass index (borderline significant P < 0.1), but negatively with calculated creatinine clearance. The standardized regression coefficient for ln (ACR) and the odds ratio for abnormal albuminuria for every 1 mg/dL increment of uric acid after adjusting for calculated creatinine clearance and other confounders were 0.138 (P < 0.05) and 1.183 (1.025-1.364), respectively. The results after excluding 127 cases with a history of hypertension were similar. CONCLUSION: Serum uric acid is an independent correlate of urinary ACR in Taiwanese patients with type 2 diabetes mellitus.     

Renal function and cardiovascular risk markers in a remote Australian Aboriginal community.

BACKGROUND: Australian Aborigines living in remote areas have exceedingly high rates of renal failure together with increased cardiovascular morbidity and mortality. To examine the basis of this association, we studied markers of renal function and cardiovascular (CV) risk in a coastal Aboriginal community in a remote area of the Northern Territory of Australia. End-stage renal disease (ESRD) incidence rates in that community are 15 times the national non-Aboriginal rate and CV mortality rates in the region are increased 5-fold. METHODS: A cross-sectional community survey was conducted. Markers of early renal disease examined included urine albumin/creatinine ratio (ACR), serum creatinine concentration and calculated glomerular filtration rate (GFR). CV risk markers included blood pressure as well as measures of glycaemia, diabetes and serum lipids. RESULTS: The study group included 237 people, 58% of the adult population of the community. The crude prevalence of microalbuminuria (urine ACR: 3.4-33.9 g/mol, 30-299 mg/g) was 31% and of overt albuminuria (urine ACR: >or=34 g/mol, >or=300 mg/g), 13%. The prevalence of overt albuminuria increased with age, but the prevalence of microalbuminuria was greatest in the 45-54 year age group. Microalbuminuria was associated with increasing body mass index, whereas overt albuminuria was associated with increasing glycated haemoglobin (HbA1c) and systolic blood pressure and a history of diabetes. The prevalence of elevated serum creatinine concentration (>or=120 micromol/l) was 10%. GFR (calculated using the MDRD equation) was <60 ml/min/1.73 m(2) in 12% and 60-79 ml/min/1.73 m(2) in a further 36% of the study population. Although many people with albuminuria had well preserved GFRs, mean GFR was lower in people with higher levels of albuminuria. CONCLUSIONS: The high prevalence of markers of renal disease in this community was consistent with their high rates of ESRD. The distribution of microalbuminuria suggested a 'cohort effect', representing a group who will progress to overt albuminuria. The powerful association of renal disease markers with CV risk factors confirms a strong link between renal and CV disease in the early, asymptomatic stages of each. Thus, pathologic albuminuria, in part, might be a manifestation of the metabolic/haemodynamic syndrome and both conditions might arise out of a common menu of risk factors. Hence, a single agenda of primary and secondary intervention may benefit both.     

Renal Dysfunction Is a Strong and Independent Risk Factor for Mortality and Cardiovascular Complications in Renal Transplantation

Renal transplant recipients (RTR) have shortened life expectancy, primarily due to premature cardiovascular disease (CVD). Traditional CVD risk factors are highly prevalent. In addition, several non-traditional risk factors may contribute to the high risk. The aim of the study was to evaluate the effects of renal dysfunction on mortality and cardiovascular complications in 1052 placebo-treated patients of the Assessment of LEscol in Renal Transplantation (ALERT) trial. Follow-up was 5-6 years and endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke. The effects of serum creatinine at baseline on these endpoints were evaluated. Elevated serum creatinine in RTR was a strong and independent risk factor for MACE, cardiac, non-cardiovascular, and all-cause mortality, but not for stroke or non-fatal MI alone. Serum creatinine was associated with increased mortality and MACE, independent of established CVD risk factors. Graft loss resulted in increased incidences of non-cardiovascular death, all-cause mortality, MACE and non-fatal MI. In conclusion, elevated serum creatinine is a strong risk factor for all-cause, non-cardiovascular and cardiac mortality, and MACE, independent of traditional risk factors, but not for stroke or non-fatal MI alone.     

Prevalence of albuminuria in Australia: the AusDiab Kidney Study

BACKGROUND: Albuminuria is an important predictor of risk of progressive renal disease, cardiovascular disease, and mortality; however, the prevalence in the general population is not well defined. We determined estimates of the population prevalence and associations of microalbuminuria and macroalbuminuria in Australian adults; 11,247 Australians aged > or = 25 years living in 42 randomly selected population clusters were tested for albuminuria (spot urine albumin:creatinine (mg/mmol): normal < 3.4, microalbuminuria 3.4 to 34, macroalbuminuria > 34). METHODS: Prevalence of micro- and macroalbuminuria were assessed with age, sex, obesity, smoking, hypertension (> or = 140/90 mm Hg or known diagnosis on treatment), glucose metabolism status (WHO criteria according to fasting glucose and oral glucose tolerance test), ischemic heart and cerebrovascular disease, and low glomerular filtration rate (calculated glomerular filtration rate < 60 mL/min/1.73m2). RESULTS: Microalbuminuria and macroalbuminuria proteinuria were present in 6.0% and 0.6% of the population, respectively. The majority of subjects with microalbuminuria (64%) and macroalbuminuria (76%) had hypertension, and approximately half of those with albuminuria had abnormal glucose metabolism. Of all participants with microalbuminuria, 25.9% had normal blood pressure and glucose metabolism, and in this group, alternative associations of microalbuminuria included obesity (13.5%), smoking (20.7%), and low glomerular filtration rate (12.3%). CONCLUSION: Albuminuria is present in a small percentage of the general adult population, but is highly prevalent in subjects with hypertension and/or abnormal glucose metabolism. The majority of cases of microalbuminuria and macroalbuminuria in the general population are among those with hypertension.     

Associations of low serum total bilirubin level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients

Objective To investigate the association of low serum total bilirubin (TBIL) level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single-center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels (interquartile range). Kaplan-Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all-cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of (48.0±15.4) years old, among whom 59.0% were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4-5.8 μmol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was statistically significant (all P＜0.05), while the difference in body mass index (BMI), estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow-up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan-Meier curves showed higher all-cause mortality in patients with TBIL≤3.4 μmol/L (Q1 group) (P=0.032) and there was no statistical difference in the cardiovascular mortality among different groups. After adjusting for biochemical indicators such as demographics, comorbidities, and liver function, taking baseline TBIL Q2 level (3.4＜TBIL≤4.5 μmol/L) as a reference, the hazard ratio for all-cause death in patients with TBIL≤3.4 μmol/L was 1.702 (95%CI 1.093-2.650, P=0.019), and the hazard ratio for cardiovascular death was 1.760 (95%CI 0.960-3.227, P=0.068). Multiple logistic regression analysis results showed that diabetes (OR=1.065, 95%CI 1.010-1.122, P=0.019) and high BMI (OR=1.838, 95%CI 1.056-3.197, P=0.031) were risk factors for baseline serum TBIL≤3.4 μmol/L. However, high hemoglobin (OR=0.990, 95%CI 0.982-0.998, P=0.011), high serum albumin (OR=0.950, 95%CI 0.916-0.985, P=0.006) and high ALT (OR=0.998, 95%CI 0.976-0.999, P=0.036) were the protective factors for patients with baseline serum TBIL≤3.4 μmol/L. Conclusion Baseline serum TBIL≤3.4 μmol/L in peritoneal dialysis patients is independently associated with all-cause mortality, and is not significantly associated with cardiovascular mortality; and baseline serum TBIL≤3.4 μmol/L occurred is associated with diabetes, high body mass index, low levels of hemoglobin, serum albumin and ALT.     

Effect of serum uric acid level on prognosis in maintenance hemodialysis patients

Objective To analyze the relationship between serum uric acid (SUA) level and clinical indicators in maintenance hemodialysis (MHD) patients, and explore its influence on all-cause mortality and cardiovascular mortality. Methods This study was a retrospective cohort study. Patients who received MHD from the blood purification center of the Third Affiliated Hospital of Sun Yat-sen University from January 1, 2011 to December 30, 2015 were enrolled in the queue. They were divided into 3 groups according to the first and third quantile of the SUA level quartiles, and the baseline data of clinical and laboratory examinations were compared. The correlation between SUA level and clinical indicators was analyzed by Pearson correlation coefficient. Kaplan-Meier method and Cox proportional hazard regression model were used to examine the association between SUA and all-cause mortality and cardiovascular mortality in MHD patients. Results A total of 201 patients were enrolled in the study. The age of the patients was (56.9±16.7) years and the baseline SUA level was (531.1±137.9) μmol/L. Patients were divided into 3 groups with the first quantile (442 μmol/L) and the third quantile (620 μmol/L) of the SUA quartiles as the boundary points: group 1 (SUA＜442 μmol/L, n=52), group 2 (SUA 442-620 μmol/L, n=101) and group 3 (SUA＞620 μmol/L, n=48). The results showed that the patients in group 1 were older and had more proportion of patients with diabetes mellitus and cardiovascular diseases than those in group 3 (all P＜0.05). Compared to group 3, the serum albumin, serum phosphorus and serum creatinine were lower in group 1, while the hypersensitive C-reactive protein was higher (all P＜0.05). Pearson correlation analysis showed that SUA level was positively correlated with albumin (r=0.135, P=0.047), blood phosphorus (r=0.269, P＜0.001) and serum creatinine (r=0.333, P＜0.001), and negatively correlated with hypersensitive C-reactive protein (r=-0.216, P=0.002). After a median follow-up of 49.8 months, 66(32.8%) all-cause deaths and 32(15.9%) cardiovascular deaths were recorded. Kaplan-Meier method showed that with the decrease of SUA, all-cause mortality (Log-rank χ2=18.27, P＜0.001) and cardiovascular mortality (Log-rank χ2=15.04, P=0.001) increased. After adjusting for age, gender, comorbidity and other factors using the Cox proportional hazards model, the all-cause mortality and cardiovascular mortality decreased by 20.1% (HR=0.799, 95% CI 0.651-0.980, P=0.031) and 29.6% (HR=0.704, 95% CI 0.524-0.946, P=0.020) for each 100 μmol/L increase in baseline SUA. Compared to group 1, all-cause mortality (HR=0.332, 95%CI 0.142-0.774, P=0.011) and cardiovascular mortality (HR=0.140, 95%CI 0.030-0.657, P=0.013) were lower in the group 3. Conclusion Low SUA level increases the risk of all-cause mortality and cardiovascular mortality in MHD patients.     

Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts

Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m2, but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m2 were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.     

Albuminuria is an independent predictor of all-cause and cardiovascular mortality in the Japanese population: the Takahata study

Background

Albuminuria is a known risk factor for cardiovascular events and premature deaths. However, the association between urinary albumin excretion and mortality is unknown in the Japanese population. To clarify this, we conducted a community-based longitudinal study.

Methods

This study included 3,445 registered Japanese subjects (mean age 62.6 years), with a 7-year follow-up. Albuminuria was defined as a urine albumin-creatinine ratio (ACR) ≥30 mg/g in the morning spot urine.

Results

Subjects with albuminuria (n = 514, 14.9 %) were older and showed a higher prevalence of hypertension, obesity, and diabetes and lower values of estimated glomerular filtration rate (eGFR) than those without albuminuria (n = 2931, 85.1 %). During the follow-up, 138 subjects died. A Kaplan–Meier analysis showed that all-cause mortality significantly increased along with the increase in urine albumin excretion (log-rank test, P < 0.001). The subjects with albuminuria showed a significantly higher mortality rate than those without albuminuria (7.4 vs. 3.4 %; log-rank test, P < 0.001). A Cox proportional hazard model analysis after adjusting for possible confounders showed that albuminuria was an independent risk factor for all-cause and cardiovascular mortality (hazard ratio [HR] 1.69, 95 % confidence interval [CI] 1.12–2.56 and HR 2.27, 95 % CI 1.10–4.70, respectively) but not for noncardiovascular mortality. These associations were preserved after excluding subjects with high ACR (≥300 mg/g).

Conclusions

Albuminuria was a risk factor for all-cause and cardiovascular mortality in the Japanese population. To detect subjects with a high risk for premature death, measuring urinary albumin excretion might be useful.