Association Between Kidney Clearance of Secretory Solutes and Cardiovascular Events: The Chronic Renal Insufficiency Cohort (CRIC) Study
| Autor: | Chen, Yan, Zelnick, Leila R, Huber, Matthew P, Wang, Ke, Bansal, Nisha, Hoofnagle, Andrew N, Paranji, Rajan K, Heckbert, Susan R, Weiss, Noel S, Go, Alan S, Hsu, Chi-Yuan, Feldman, Harold I, Waikar, Sushrut S, Mehta, Rupal C, Srivastava, Anand, Seliger, Stephen L, Lash, James P, Porter, Anna C, Raj, Dominic S, Kestenbaum, Bryan R, CRIC Study Investigators |
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| Rok vydání: | 2021 |
| Předmět: |
Male
protein-bound Kidney Disease uremic toxins Myocardial Infarction Organic Anion Transporters heart failure Kynurenic Acid secretory solute clearance Cardiovascular tiglylglycine Cohort Studies Cresols Tandem Mass Spectrometry cardiovascular disease kynurenic acid Prospective Studies Renal Insufficiency Chronic Chromatography Liquid glomerular filtration rate Incidence Middle Aged Urology & Nephrology stroke tubular secretion Stroke Kidney Tubules myocardial infarction Heart Disease pyridoxic acid Public Health and Health Services xanthosine Female Pyridoxic Acid Glomerular Filtration Rate Clinical Sciences Glycine Renal and urogenital Sulfuric Acid Esters isovalerylglycine cinnamoylglycine Clinical Research proximal tubule Humans Albuminuria tubular secretory clearance indoxyl sulfate Proportional Hazards Models Aged Heart Failure Prevention renal function p-cresol sulfate Xanthines CRIC Study Investigators Ribonucleosides Indican chronic kidney disease |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 78, iss 2 |
| Popis: | Rationale & objectiveThe clearance of protein-bound solutes by the proximal tubules is an innate kidney mechanism for removing putative uremic toxins that could exert cardiovascular toxicity in humans. However, potential associations between impaired kidney clearances of secretory solutes and cardiovascular events among patients with chronic kidney disease (CKD) remains uncertain.Study designA multicenter, prospective, cohort study.Setting & participantsWe evaluated 3,407 participants from the Chronic Renal Insufficiency Cohort (CRIC) study.ExposuresBaseline kidney clearances of 8 secretory solutes. We measured concentrations of secretory solutes in plasma and paired 24-hour urine specimens using liquid chromatography-tandem mass spectrometry (LC-MS/MS).OutcomesIncident heart failure, myocardial infarction, and stroke events.Analytical approachWe used Cox regression to evaluate associations of baseline secretory solute clearances with incident study outcomes adjusting for estimated GFR (eGFR) and other confounders.ResultsParticipants had a mean age of 56 years; 45% were women; 41% were Black; and the median estimated glomerular filtration rate (eGFR) was 43 mL/min/1.73 m2. Lower 24-hour kidney clearance of secretory solutes were associated with incident heart failure and myocardial infarction but not incident stroke over long-term follow-up after controlling for demographics and traditional risk factors. However, these associations were attenuated and not statistically significant after adjustment for eGFR.LimitationsExclusion of patients with severely reduced eGFR at baseline; measurement variability in secretory solutes clearances.ConclusionsIn a national cohort study of CKD, no clinically or statistically relevant associations were observed between the kidney clearances of endogenous secretory solutes and incident heart failure, myocardial infarction, or stroke after adjustment for eGFR. These findings suggest that tubular secretory clearance provides little additional information about the development of cardiovascular disease events beyond glomerular measures of GFR and albuminuria among patients with mild-to-moderate CKD. |
| Databáze: | OpenAIRE |
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