上海市松江区成年人高尿酸血症与慢性肾病关系的队列研究

Association of hyperuricemia with risk of incident chronic kidney disease in adult in Songjiang district,Shanghai:a follow-up study

目的分析社区成年人高尿酸血症(HUA)与慢性肾病(CKD)发病风险的关系。方法基于华东区域自然人群队列,对7276例基线时未患CKD的上海市松江区20~74岁常住居民进行基于社区的前瞻性队列研究。CKD的诊断根据美国肾脏基金会慢性肾脏病实践指南的标准,HUA定义为血清尿酸(SUA)>420μmol/L(男性)或>360μmol/L(女性)。采用Cox比例风险模型分析HUA与CKD发病风险的关联。结果经过中位时间2.65年的随访,队列人群新发CKD病例301例,累积发病率为4.14%,发病密度为16.01/1000人年(95%CI:14.20~17.82)。CKD发病人群HUA的基线患病率显著高于非CKD发病人群。多因素Cox回归分析显示,HUA与CKD发病风险呈显著正关联,HUA患者的CKD发病风险HR值为1.92(95%CI:1.46~2.53)。在对性别、年龄、BMI、2型糖尿病、高血压等因素分层后,HUA与CKD发病风险仍呈显著正关联;在相加模型中,年龄与HUA存在交互作用,交互作用指数为1.78(95%CI:1.18~2.68)。结论上海市松江区成年人CKD的发病率较高,HUA为CKD发病的独立危险因素。

Objective To evaluate the association of hyperuricemia with the risk for chronic kidney disease(CKD)in community adults.Methods A community-based follow-up study comprising of 7276 adults aged 20-74 years who attended the natural population cohort in Eastern China and had no CKD at baseline survey was performed in the Songjiang district,Shanghai.CKD was diagnosed according to the National Kidney Foundation Practice Guidelines for Chronic Kidney Disease criteria.Hyperuricemia was defined as serum uric acid level>420μmol/L for men and>360μmol/L for women.Cox proportional hazards model was used to examine the association of hyperuricemia with the risk for CKD.Results During a median follow-up period of 2.65 year,301 participants were newly diagnosed with CKD.The cumulative incidence rate and incidence density of CKD were 4.14%,and 16.01/1000 person-years(95%CI:14.20-17.82),respectively.A higher prevalence of hyperuricemia was observed in subjects with CKD compared with those without CKD.Multivariate Cox regression model analysis showed that hyperuricemia was associated with the increased risk for CKD,with an adjusted HR of 1.92(95%CI:1.46-2.53).Their positive associations remained in almost all the subgroups,including sex,age(<60,≥60 years),BMI(<25.0,≥25.0 kg/m2),type 2 diabetes,and hypertension.A significant synergistic effect of the interaction between age and hyperuricemia on CKD was found,and the synergy index was 1.78(95%CI:1.18-2.68).Conclusion The incidence of CKD in adults in Songjiang district was relatively high.Hyperuricemia is an independent risk factor for the development of CKD.