JASN:尿铵可以预测高血压肾病患者的临床结局!

2017-04-07 xing.T MedSci原创

总之,低铵排泄与高血压肾病患者的死亡和肾功能衰竭相关,即使在那些没有酸中毒的患者中。低铵排泄可以识别正常碳酸氢盐水平的CKD患者,这些患者可能会从酸中毒发生前输入碱性药物进行治疗中受益。

代谢性酸中毒与CKD预后不良有关。由于肾脏氨排泄受损在酸中毒的发病机制中发挥着重要作用,尿铵排泄可能是一个比血清碳酸氢盐更好的、也许更早的酸碱指示剂,特别是在没有酸中毒的患者中。

近日,肾脏病领域权威杂志Journal of the American Society of Nephrology上发表一篇研究文章,研究人员在非洲裔美国人肾脏疾病和高血压研究参与者(n=1044)中,评估了基线铵排泄和患者临床结局之间的相关性。

平均每日铵排泄率为19.5mEq(95%可信区间[95%CI]为6.5-43.2)。在Cox回归模型中(调整人口结构、测定的肾小球滤过率、蛋白尿、体重指数、内源性酸产生、血清钾和碳酸氢钠后),每日铵排泄量位于低三分位数范围的患者相比于高三分位数范围的患者发生死亡或透析的复合终点的风险比为1.46(95%CI为1.13-1.87的低水平)和而中三分位数范围的患者相比于高三分位数范围的患者为1.14(95%CI,0.89-1.46)。

在无基础酸中毒的参与者中,那些铵排泄<20mEq/d的患者相比于那些铵排泄>20mEq/d的患者调整后的风险比为1.36(95%CI为1.09-1.71)。此外,相比于位于高三分位数范围的参与者,那些位于低三分位数范围的参与者有较高的调整后1年酸中毒发生率(调整后的比值比为2.56;95%CI为1.04-6.27)。

总之,低铵排泄与高血压肾病患者的死亡和肾功能衰竭相关,即使在那些没有酸中毒的患者中。低铵排泄可以识别正常碳酸氢盐水平的CKD患者,这些患者可能会从酸中毒发生前输入碱性药物进行治疗中受益。

原始出处:

Kalani L. Raphael,et al. Urine Ammonium Predicts Clinical Outcomes in Hypertensive Kidney Disease. JASN, 2017,http://jasn.asnjournals.org/content/early/2017/04/05/ASN.2016101151.abstract

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2025806, encodeId=64522025806e6, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Wed May 17 15:10:00 CST 2017, time=2017-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843110, encodeId=0c0b18431103d, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Fri Feb 23 01:10:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1941302, encodeId=e4c6194130290, content=<a href='/topic/show?id=bd2f28e0e1' target=_blank style='color:#2F92EE;'>#ASN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2870, encryptionId=bd2f28e0e1, topicName=ASN)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Mon Oct 02 23:10:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055356, encodeId=ddd22055356c3, content=<a href='/topic/show?id=d4d8102e07a1' target=_blank style='color:#2F92EE;'>#高血压肾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102707, encryptionId=d4d8102e07a1, topicName=高血压肾病)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKQBvJI9WesEs5nl29JIJ7mAquShibzBHQmTeHHwZMDlIzc5qoQUhTJOpOwiaxYa9UcibrZviaM7dL7aQ/132, createdBy=35cb2500499, createdName=ms1343860338762272, createdTime=Mon Sep 18 15:10:00 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2025806, encodeId=64522025806e6, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Wed May 17 15:10:00 CST 2017, time=2017-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843110, encodeId=0c0b18431103d, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Fri Feb 23 01:10:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1941302, encodeId=e4c6194130290, content=<a href='/topic/show?id=bd2f28e0e1' target=_blank style='color:#2F92EE;'>#ASN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2870, encryptionId=bd2f28e0e1, topicName=ASN)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Mon Oct 02 23:10:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055356, encodeId=ddd22055356c3, content=<a href='/topic/show?id=d4d8102e07a1' target=_blank style='color:#2F92EE;'>#高血压肾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102707, encryptionId=d4d8102e07a1, topicName=高血压肾病)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKQBvJI9WesEs5nl29JIJ7mAquShibzBHQmTeHHwZMDlIzc5qoQUhTJOpOwiaxYa9UcibrZviaM7dL7aQ/132, createdBy=35cb2500499, createdName=ms1343860338762272, createdTime=Mon Sep 18 15:10:00 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2025806, encodeId=64522025806e6, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Wed May 17 15:10:00 CST 2017, time=2017-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843110, encodeId=0c0b18431103d, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Fri Feb 23 01:10:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1941302, encodeId=e4c6194130290, content=<a href='/topic/show?id=bd2f28e0e1' target=_blank style='color:#2F92EE;'>#ASN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2870, encryptionId=bd2f28e0e1, topicName=ASN)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Mon Oct 02 23:10:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055356, encodeId=ddd22055356c3, content=<a href='/topic/show?id=d4d8102e07a1' target=_blank style='color:#2F92EE;'>#高血压肾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102707, encryptionId=d4d8102e07a1, topicName=高血压肾病)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKQBvJI9WesEs5nl29JIJ7mAquShibzBHQmTeHHwZMDlIzc5qoQUhTJOpOwiaxYa9UcibrZviaM7dL7aQ/132, createdBy=35cb2500499, createdName=ms1343860338762272, createdTime=Mon Sep 18 15:10:00 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-10-02 chenhongpeng
  4. [GetPortalCommentsPageByObjectIdResponse(id=2025806, encodeId=64522025806e6, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Wed May 17 15:10:00 CST 2017, time=2017-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843110, encodeId=0c0b18431103d, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Fri Feb 23 01:10:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1941302, encodeId=e4c6194130290, content=<a href='/topic/show?id=bd2f28e0e1' target=_blank style='color:#2F92EE;'>#ASN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2870, encryptionId=bd2f28e0e1, topicName=ASN)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Mon Oct 02 23:10:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055356, encodeId=ddd22055356c3, content=<a href='/topic/show?id=d4d8102e07a1' target=_blank style='color:#2F92EE;'>#高血压肾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102707, encryptionId=d4d8102e07a1, topicName=高血压肾病)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKQBvJI9WesEs5nl29JIJ7mAquShibzBHQmTeHHwZMDlIzc5qoQUhTJOpOwiaxYa9UcibrZviaM7dL7aQ/132, createdBy=35cb2500499, createdName=ms1343860338762272, createdTime=Mon Sep 18 15:10:00 CST 2017, time=2017-09-18, status=1, ipAttribution=)]