Nephrol Dial Transplant (2015) 30: 996–1001 doi: 10.1093/ndt/gfv109
Original Articles High estimated glomerular filtration rate is associated with coronary artery calcification in middle-aged Korean men without chronic kidney disease
1
Department of Internal Medicine, Myongji Hospital, Goyang-si Gyeonggi-do, Republic of Korea and 2Department of Internal Medicine, Kangbuk
Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Correspondence and offprint requests to: Young Youl Hyun; E-mail: [email protected]
Keywords: cardiovascular disease, computed tomography, coronary artery disease, eGFR, hyperfiltration
A B S T R AC T Background. High estimated glomerular filtration rate (eGFR) as well as low eGFR is associated with cardiovascular morbidity and mortality. Vascular calcification is a suggested link between low eGFR and worse cardiovascular outcome. However, the association between high eGFR and vascular calcification is not known. The aim of this study is to investigate the relationship between high eGFR and coronary artery calcification (CAC). Methods. This cross-sectional study analyzed middle-aged Korean men in whom coronary artery calcium scores (CACS) and eGFR were measured as part of a health examination program in Korea. Participants with underlying chronic kidney disease (CKD), cardiovascular disease (CVD) and cancer were excluded. CAC was defined as a CACS >100. Results. Among 6986 subjects [age 48.1 (46.5–50.5) years], 321 (4.6%) participants had CAC. The percentages of participants with CAC were 5.7, 3.8, 4.9 and 6.6 in groups with eGFR (mL/min/1.73 m2) of 60∼74, 75∼89, 90∼104 and 105∼max, respectively. According to multivariate analysis, the odds ratio for CAC in the group with eGFR of 105∼max compared with the group with eGFR of 75∼89 was 2.52 (1.67–3.79, P < 0.001) after adjustment for age, body mass index, diabetes, hypertension, systolic blood pressure, glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, hsCRP, calcium, phosphorus, current smoking, alcohol intake and vigorous exercise frequency. Conclusions. High eGFR is associated with CAC in middleaged Korean men without CKD. Further studies are needed to verify a causal relationship and clarify the role of high eGFR in the development of CVD. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
INTRODUCTION Decreased estimated glomerular filtration rate (eGFR) is a wellknown risk factor for high all-cause death, cardiovascular events and cardiovascular death [1–3]. Vascular calcification is an important explanation for the adverse outcomes observed in chronic kidney disease (CKD). The level of coronary artery calcification (CAC) measured by computed tomography (CT) is useful for non-invasively and quantitatively predicting cardiovascular outcome [4]. CAC is typically increased in dialysis patients [5] and is also associated with lower eGFR in CKD patients not on dialysis [6]. Furthermore, CAC is a strong predictor of mortality and cardiovascular events in patients with CKD [7]. Importantly, both high and low eGFR are associated with adverse outcomes, although the underlying mechanism is not clear [8]. Previous studies have shown that eGFR has a u-shape relationship with cardiovascular outcome and all-cause mortality [3, 9]. Most studies on the relationship between eGFR and vascular calcification have focused on decreased eGFR, and there are little data in subjects without CKD. Verification of the association between high eGFR and vascular calcification will be helpful in understanding the mechanism underlying worse cardiovascular outcome in subjects with high eGFR. The aim of this study is to investigate the relationship between high eGFR and CAC by analyzing coronary artery calcium scores (CACS) form middle-aged Korean men who participated in a health check-up program. 996
Downloaded from http://ndt.oxfordjournals.org/ at FU BerlinFB Humanmedizin on June 25, 2015
Hye Min Choi1, Young Youl Hyun2, Kyu Beck Lee2 and Hyang Kim2
M AT E R I A L S A N D M E T H O D S
F I G U R E 1 : Algorithm for selecting study subjects from health check-up participants. CT, computed tomography; CVD, cardiovascular disease.
High eGFR and coronary calcification
Statistical analysis Participants were divided into four groups according to their eGFR level (60∼74, 75∼89, 90∼104 and 105∼maximum mL/ min/1.73 m2). Continuous variables were expressed as the mean ± standard deviation or median (interquartile range). Continuous variables were compared between two groups using a t-test or the Mann–Whitney U-test, and continuous variables were compared between four groups using analysis of variance or the Kruskal–Wallis test. Categorical variables were expressed as percentages and compared between groups using the χ 2 test. Logistic regression analysis was used to determine the odds ratio (OR) and confidence interval (CI) for the presence of CAC associated with different eGFR levels compared with the reference range group. Subgroup analyses were performed for participants without risk factors such as hypertension, diabetes mellitus and abnormal BMI. Statistical
997
ORIGINAL ARTICLE
Clinical and laboratory measurements Data regarding medical history, medication usage and healthrelated behaviors were collected through a self-administered questionnaire. Trained staff collected anthropometry, blood pressure and serum biochemical measures. A more detailed protocol of this examination program has been previously described [10]. In addition, trained nurses measured height and weight with an automated scale while the participants were wearing a light hospital gown and no shoes. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Blood samples were taken from an antecubital vein after fasting for at least 10 h. Serum total cholesterol, triglycerides and uric acid levels were determined using an enzymatic colorimetric assay. Low-density lipoprotein (LDL) cholesterol and highdensity lipoprotein (HDL) cholesterol were measured directly using a homogeneous enzymatic colorimetric assay. Serum high-sensitivity C-reactive protein (hsCRP) was determined
Downloaded from http://ndt.oxfordjournals.org/ at FU BerlinFB Humanmedizin on June 25, 2015
Study design and population This is a cross-sectional study designed to examine the association between high eGFR and CAC in relatively healthy middle-aged Korean men without chronic kidney disease. Study subjects were participants at health maintenance exams at the Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea. A total of 9194 middle-aged men between 45 and 60 years old underwent coronary computed tomographic scan from 2010 to 2012, and they were considered for inclusion in this study. There were 1702 records with missing data regarding the variables of interest, which were excluded. A total of 506 participants with underlying CKD, history of cardiovascular disease (CVD) and history of cancer were excluded (CKD, n = 180; history of CVD, n = 175; history of cancer, n = 171). CKD was defined as an eGFR under 60 mL/min/1.73 m2 or as dipstick proteinuria ≥1+ at baseline exam. The final analysis included 6986 participants. Figure 1 summarizes the process of recruiting this study population. This study was approved by the institutional review board at Kangbuk Samsung Hospital.
using a particle-enhanced immunoturbidimetric assay on a Modular Analytics P800 apparatus (Roche Diagnostics). Serum insulin was measured using an electrochemiluminescence immunoassay on a Modular Analytics E170 apparatus (Roche Diagnostics). Serum glucose was measured using the hexokinase method on a Cobas Integra 800 apparatus (Roche Diagnostics; Rotkreuz, Switzerland). Insulin resistance was assessed with a homeostatic model assessment of insulin resistance (HOMA-IR) according to the following equation: fasting blood insulin (uU/mL) × fasting serum glucose (mg/dL)/405. Serum creatinine levels were measured by the isotope dilution mass spectroscopy-traceable method using Modular D2400 (Roche, Tokyo, Japan). eGFR was calculated using the CKD epidemiology collaboration (CKD-EPI) equation [11] as follows: eGFR = 141 × min (serum creatinine/κ,1)α × max (serum creatinine/κ,1)−1.209 × 0.993age × 1.018 (if female) × 1.159 (if black), where κ = 0.7 for females and 0.9 for males, α = −0.329 for females and −0.411 for males, min indicates the minimum of serum creatinine/κ or 1, and max indicates the maximum of serum creatinine/κ or 1. The Laboratory Medicine Department at Kangbuk Samsung Hospital in Seoul, Korea has been accredited by the Korean Society of Laboratory Medicine and the Korean Association of Quality Assurance for Clinical Laboratories. The laboratory participates in the College of American Pathologists survey proficiency testing. CT scans were performed with a Lightspeed VCT XTe-64 slice MDCT scanner (GE Healthcare, Tokyo, Japan) using a standard scanning protocol described as follows: 2.5 mm thickness, 400 ms rotation time, 120 kV tube voltage and a 124 mAS (310 mA × 0.4 s) tube current under electrocardiography-gated dose modulation. The quantitative CACS were calculated according to a method described by Agatston et al. [4]. In the present study, presence of CAC was defined as a CACS >100. Hypertension was defined as a systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, or by a history of hypertension or medication for hypertension. Diabetes mellitus was defined by a fasting serum glucose >126 mg/dL, by a history of diabetes or by the use of medication for diabetes. CVD was defined by a history of heart disease, coronary disease or stroke.
analyses were performed using Stata Version 13 (StataCorp LP, College Station, TX, USA).
The baseline characteristics of study participants according to eGFR category are summarized in Table 1. All variables except systolic BP, diastolic BP, HDL cholesterol and phosphorus showed differences across eGFR ranges (P < 0.05). Overall, 321 (4.6%) participants had CAC and 6665 (95.4%) participants had no CAC. Among those with CAC, 252 (3.6%) participants had CACS of 100∼399, 48 (0.7%) participants had CACS of 400∼799 and only 21 (0.3%) participants had CACS more than 800. The percent with CAC was lowest with eGFR of 75∼89 and highest with eGFR of 105∼maximum. The difference between the two groups was statistically significant in χ2 test with Bonferroni adjustment (3.8% versus 6.6%, P = 0.002). The characteristics of participants with CAC were compared with those without CAC, as given in Table 2. As expected, participants with CAC had metabolically worse profiles. They had higher age, BMI, systolic BP, diastolic BP, serum glucose and HOMA-IR along with lower HDL cholesterol. Diabetes and hypertension were more common in participants with CAC. However, more participants with CAC performed vigorous exercise more than once a week. Table 3 summarizes the results of multivariate logistic regression analysis and shows the association between eGFR and CAC. After adjustment for cardiovascular risk factors, the
DISCUSSION This study found that high eGFR is associated with CAC in middle-aged Korean men who participated in a health check-up
Table 1. Characteristics of participants according to eGFR category Characteristics
No. of patients CAC (%) Age (years) BMI (kg/m2) Systolic BP (mmHg) Diastolic BP (mmHg) Glucose (mg/dL) HOMA-IR Total cholesterol (mg/dL) LDL cholesterol (mg/dL) HDL cholesterol (mg/dL) Triglyceride (mg/dL) Uric acid (mg/dL) Calcium (mg/dL) Phosphorus (mg/dL) Creatinine (mg/dL) eGFR (mL/min/1.73 m2) hsCRP (mg/dL) Diabetes Hypertension Current smoking Alcohol intake (g/day) Vigorous exercise (more than once a week)
Overall
6986 321 (4.6%) 48.1 [46.5–50.5] 24.7 ± 2.6 116 ± 12 76 ± 9 101 ± 18 1.24 [0.82–1.87] 206 ± 35 131 ± 32 52 ± 12 127 [92–180] 6.0 ± 1.2 9.4 ± 0.3 3.49 ± 0.42 0.99 ± 0.12 89.3 [79.9–100.6] 0.06 [0.03–0.11] 699 (10.0%) 1836 (26.3%) 2432 (34.8%) 14 [6–32] 2121 (38.5%)
eGFR category (mL/min/1.73 m2)
P-value
60∼74
75∼89
90∼104
105∼maximum
761 43 (5.7%) 48.5 [46.7–51.5] 25.1 ± 2.5 117 ± 13 77 ± 10 101 ± 14 1.25 [0.86–1.96] 212 ± 36 136 ± 33 51 ± 12 128 [98–176] 6.5 ± 1.3 9.5 ± 0.3 3.51 ± 0.44 1.21 ± 0.05 70.8 [68.8–71.8] 0.06 [0.04–0.11] 80 (10.5%) 238 (31.3%) 205 (26.9%) 13 [4–27] 232 (38.5%)
3203 120 (3.8%) 48.4 [46.8–50.6] 24.7 ± 2.5 116 ± 12 76 ± 9 101 ± 14 1.24 [0.83–1.84] 207 ± 34 132 ± 31 52 ± 12 128 [92–178] 6.1 ± 1.2 9.4 ± 0.3 3.49 ± 0.42 1.04 ± 0.05 86.1 [79.4–88.6] 0.05 [0.03–0.10] 276 (8.6%) 818 (25.5%) 1031 (32.2%) 14 [6–31] 991 (39.3%)
2446 120 (4.9%) 48.2 [46.0–51.0] 24.6 ± 2.7 116 ± 12 76 ± 9 101 ± 19 1.21 [0.79–1.84] 204 ± 35 130 ± 32 52 ± 12 125 [89–177] 5.7 ± 1.2 9.3 ± 0.3 3.48 ± 0.42 0.90 ± 0.05 100.4 [98.2–101.9] 0.06 [0.03–0.11] 252 (10.3%) 636 (26.0%) 921 (37.7%) 14 [6–34] 750 (39.0%)
576 38 (6.6%) 46.8 [45.9–48.0] 24.4 ± 2.8 117 ± 13 76 ± 10 106 ± 30 1.29 [0.85–2.00] 203 ± 37 127 ± 33 52 ± 13 137 [92–201] 5.5 ± 1.2 9.3 ± 0.3 3.48 ± 0.43 0.78 ± 0.05 107.1 [106.2–107.8] 0.06 [0.03–0.12] 91 (15.8%) 144 (25.0%) 275 (47.7%) 18 [8–36] 148 (31.7%)
0.008
Original Articles High estimated glomerular filtration rate is associated with coronary artery calcification in middle-aged Korean men without chronic kidney disease
1
Department of Internal Medicine, Myongji Hospital, Goyang-si Gyeonggi-do, Republic of Korea and 2Department of Internal Medicine, Kangbuk
Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Correspondence and offprint requests to: Young Youl Hyun; E-mail: [email protected]
Keywords: cardiovascular disease, computed tomography, coronary artery disease, eGFR, hyperfiltration
A B S T R AC T Background. High estimated glomerular filtration rate (eGFR) as well as low eGFR is associated with cardiovascular morbidity and mortality. Vascular calcification is a suggested link between low eGFR and worse cardiovascular outcome. However, the association between high eGFR and vascular calcification is not known. The aim of this study is to investigate the relationship between high eGFR and coronary artery calcification (CAC). Methods. This cross-sectional study analyzed middle-aged Korean men in whom coronary artery calcium scores (CACS) and eGFR were measured as part of a health examination program in Korea. Participants with underlying chronic kidney disease (CKD), cardiovascular disease (CVD) and cancer were excluded. CAC was defined as a CACS >100. Results. Among 6986 subjects [age 48.1 (46.5–50.5) years], 321 (4.6%) participants had CAC. The percentages of participants with CAC were 5.7, 3.8, 4.9 and 6.6 in groups with eGFR (mL/min/1.73 m2) of 60∼74, 75∼89, 90∼104 and 105∼max, respectively. According to multivariate analysis, the odds ratio for CAC in the group with eGFR of 105∼max compared with the group with eGFR of 75∼89 was 2.52 (1.67–3.79, P < 0.001) after adjustment for age, body mass index, diabetes, hypertension, systolic blood pressure, glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, hsCRP, calcium, phosphorus, current smoking, alcohol intake and vigorous exercise frequency. Conclusions. High eGFR is associated with CAC in middleaged Korean men without CKD. Further studies are needed to verify a causal relationship and clarify the role of high eGFR in the development of CVD. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
INTRODUCTION Decreased estimated glomerular filtration rate (eGFR) is a wellknown risk factor for high all-cause death, cardiovascular events and cardiovascular death [1–3]. Vascular calcification is an important explanation for the adverse outcomes observed in chronic kidney disease (CKD). The level of coronary artery calcification (CAC) measured by computed tomography (CT) is useful for non-invasively and quantitatively predicting cardiovascular outcome [4]. CAC is typically increased in dialysis patients [5] and is also associated with lower eGFR in CKD patients not on dialysis [6]. Furthermore, CAC is a strong predictor of mortality and cardiovascular events in patients with CKD [7]. Importantly, both high and low eGFR are associated with adverse outcomes, although the underlying mechanism is not clear [8]. Previous studies have shown that eGFR has a u-shape relationship with cardiovascular outcome and all-cause mortality [3, 9]. Most studies on the relationship between eGFR and vascular calcification have focused on decreased eGFR, and there are little data in subjects without CKD. Verification of the association between high eGFR and vascular calcification will be helpful in understanding the mechanism underlying worse cardiovascular outcome in subjects with high eGFR. The aim of this study is to investigate the relationship between high eGFR and CAC by analyzing coronary artery calcium scores (CACS) form middle-aged Korean men who participated in a health check-up program. 996
Downloaded from http://ndt.oxfordjournals.org/ at FU BerlinFB Humanmedizin on June 25, 2015
Hye Min Choi1, Young Youl Hyun2, Kyu Beck Lee2 and Hyang Kim2
M AT E R I A L S A N D M E T H O D S
F I G U R E 1 : Algorithm for selecting study subjects from health check-up participants. CT, computed tomography; CVD, cardiovascular disease.
High eGFR and coronary calcification
Statistical analysis Participants were divided into four groups according to their eGFR level (60∼74, 75∼89, 90∼104 and 105∼maximum mL/ min/1.73 m2). Continuous variables were expressed as the mean ± standard deviation or median (interquartile range). Continuous variables were compared between two groups using a t-test or the Mann–Whitney U-test, and continuous variables were compared between four groups using analysis of variance or the Kruskal–Wallis test. Categorical variables were expressed as percentages and compared between groups using the χ 2 test. Logistic regression analysis was used to determine the odds ratio (OR) and confidence interval (CI) for the presence of CAC associated with different eGFR levels compared with the reference range group. Subgroup analyses were performed for participants without risk factors such as hypertension, diabetes mellitus and abnormal BMI. Statistical
997
ORIGINAL ARTICLE
Clinical and laboratory measurements Data regarding medical history, medication usage and healthrelated behaviors were collected through a self-administered questionnaire. Trained staff collected anthropometry, blood pressure and serum biochemical measures. A more detailed protocol of this examination program has been previously described [10]. In addition, trained nurses measured height and weight with an automated scale while the participants were wearing a light hospital gown and no shoes. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Blood samples were taken from an antecubital vein after fasting for at least 10 h. Serum total cholesterol, triglycerides and uric acid levels were determined using an enzymatic colorimetric assay. Low-density lipoprotein (LDL) cholesterol and highdensity lipoprotein (HDL) cholesterol were measured directly using a homogeneous enzymatic colorimetric assay. Serum high-sensitivity C-reactive protein (hsCRP) was determined
Downloaded from http://ndt.oxfordjournals.org/ at FU BerlinFB Humanmedizin on June 25, 2015
Study design and population This is a cross-sectional study designed to examine the association between high eGFR and CAC in relatively healthy middle-aged Korean men without chronic kidney disease. Study subjects were participants at health maintenance exams at the Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea. A total of 9194 middle-aged men between 45 and 60 years old underwent coronary computed tomographic scan from 2010 to 2012, and they were considered for inclusion in this study. There were 1702 records with missing data regarding the variables of interest, which were excluded. A total of 506 participants with underlying CKD, history of cardiovascular disease (CVD) and history of cancer were excluded (CKD, n = 180; history of CVD, n = 175; history of cancer, n = 171). CKD was defined as an eGFR under 60 mL/min/1.73 m2 or as dipstick proteinuria ≥1+ at baseline exam. The final analysis included 6986 participants. Figure 1 summarizes the process of recruiting this study population. This study was approved by the institutional review board at Kangbuk Samsung Hospital.
using a particle-enhanced immunoturbidimetric assay on a Modular Analytics P800 apparatus (Roche Diagnostics). Serum insulin was measured using an electrochemiluminescence immunoassay on a Modular Analytics E170 apparatus (Roche Diagnostics). Serum glucose was measured using the hexokinase method on a Cobas Integra 800 apparatus (Roche Diagnostics; Rotkreuz, Switzerland). Insulin resistance was assessed with a homeostatic model assessment of insulin resistance (HOMA-IR) according to the following equation: fasting blood insulin (uU/mL) × fasting serum glucose (mg/dL)/405. Serum creatinine levels were measured by the isotope dilution mass spectroscopy-traceable method using Modular D2400 (Roche, Tokyo, Japan). eGFR was calculated using the CKD epidemiology collaboration (CKD-EPI) equation [11] as follows: eGFR = 141 × min (serum creatinine/κ,1)α × max (serum creatinine/κ,1)−1.209 × 0.993age × 1.018 (if female) × 1.159 (if black), where κ = 0.7 for females and 0.9 for males, α = −0.329 for females and −0.411 for males, min indicates the minimum of serum creatinine/κ or 1, and max indicates the maximum of serum creatinine/κ or 1. The Laboratory Medicine Department at Kangbuk Samsung Hospital in Seoul, Korea has been accredited by the Korean Society of Laboratory Medicine and the Korean Association of Quality Assurance for Clinical Laboratories. The laboratory participates in the College of American Pathologists survey proficiency testing. CT scans were performed with a Lightspeed VCT XTe-64 slice MDCT scanner (GE Healthcare, Tokyo, Japan) using a standard scanning protocol described as follows: 2.5 mm thickness, 400 ms rotation time, 120 kV tube voltage and a 124 mAS (310 mA × 0.4 s) tube current under electrocardiography-gated dose modulation. The quantitative CACS were calculated according to a method described by Agatston et al. [4]. In the present study, presence of CAC was defined as a CACS >100. Hypertension was defined as a systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, or by a history of hypertension or medication for hypertension. Diabetes mellitus was defined by a fasting serum glucose >126 mg/dL, by a history of diabetes or by the use of medication for diabetes. CVD was defined by a history of heart disease, coronary disease or stroke.
analyses were performed using Stata Version 13 (StataCorp LP, College Station, TX, USA).
The baseline characteristics of study participants according to eGFR category are summarized in Table 1. All variables except systolic BP, diastolic BP, HDL cholesterol and phosphorus showed differences across eGFR ranges (P < 0.05). Overall, 321 (4.6%) participants had CAC and 6665 (95.4%) participants had no CAC. Among those with CAC, 252 (3.6%) participants had CACS of 100∼399, 48 (0.7%) participants had CACS of 400∼799 and only 21 (0.3%) participants had CACS more than 800. The percent with CAC was lowest with eGFR of 75∼89 and highest with eGFR of 105∼maximum. The difference between the two groups was statistically significant in χ2 test with Bonferroni adjustment (3.8% versus 6.6%, P = 0.002). The characteristics of participants with CAC were compared with those without CAC, as given in Table 2. As expected, participants with CAC had metabolically worse profiles. They had higher age, BMI, systolic BP, diastolic BP, serum glucose and HOMA-IR along with lower HDL cholesterol. Diabetes and hypertension were more common in participants with CAC. However, more participants with CAC performed vigorous exercise more than once a week. Table 3 summarizes the results of multivariate logistic regression analysis and shows the association between eGFR and CAC. After adjustment for cardiovascular risk factors, the
DISCUSSION This study found that high eGFR is associated with CAC in middle-aged Korean men who participated in a health check-up
Table 1. Characteristics of participants according to eGFR category Characteristics
No. of patients CAC (%) Age (years) BMI (kg/m2) Systolic BP (mmHg) Diastolic BP (mmHg) Glucose (mg/dL) HOMA-IR Total cholesterol (mg/dL) LDL cholesterol (mg/dL) HDL cholesterol (mg/dL) Triglyceride (mg/dL) Uric acid (mg/dL) Calcium (mg/dL) Phosphorus (mg/dL) Creatinine (mg/dL) eGFR (mL/min/1.73 m2) hsCRP (mg/dL) Diabetes Hypertension Current smoking Alcohol intake (g/day) Vigorous exercise (more than once a week)
Overall
6986 321 (4.6%) 48.1 [46.5–50.5] 24.7 ± 2.6 116 ± 12 76 ± 9 101 ± 18 1.24 [0.82–1.87] 206 ± 35 131 ± 32 52 ± 12 127 [92–180] 6.0 ± 1.2 9.4 ± 0.3 3.49 ± 0.42 0.99 ± 0.12 89.3 [79.9–100.6] 0.06 [0.03–0.11] 699 (10.0%) 1836 (26.3%) 2432 (34.8%) 14 [6–32] 2121 (38.5%)
eGFR category (mL/min/1.73 m2)
P-value
60∼74
75∼89
90∼104
105∼maximum
761 43 (5.7%) 48.5 [46.7–51.5] 25.1 ± 2.5 117 ± 13 77 ± 10 101 ± 14 1.25 [0.86–1.96] 212 ± 36 136 ± 33 51 ± 12 128 [98–176] 6.5 ± 1.3 9.5 ± 0.3 3.51 ± 0.44 1.21 ± 0.05 70.8 [68.8–71.8] 0.06 [0.04–0.11] 80 (10.5%) 238 (31.3%) 205 (26.9%) 13 [4–27] 232 (38.5%)
3203 120 (3.8%) 48.4 [46.8–50.6] 24.7 ± 2.5 116 ± 12 76 ± 9 101 ± 14 1.24 [0.83–1.84] 207 ± 34 132 ± 31 52 ± 12 128 [92–178] 6.1 ± 1.2 9.4 ± 0.3 3.49 ± 0.42 1.04 ± 0.05 86.1 [79.4–88.6] 0.05 [0.03–0.10] 276 (8.6%) 818 (25.5%) 1031 (32.2%) 14 [6–31] 991 (39.3%)
2446 120 (4.9%) 48.2 [46.0–51.0] 24.6 ± 2.7 116 ± 12 76 ± 9 101 ± 19 1.21 [0.79–1.84] 204 ± 35 130 ± 32 52 ± 12 125 [89–177] 5.7 ± 1.2 9.3 ± 0.3 3.48 ± 0.42 0.90 ± 0.05 100.4 [98.2–101.9] 0.06 [0.03–0.11] 252 (10.3%) 636 (26.0%) 921 (37.7%) 14 [6–34] 750 (39.0%)
576 38 (6.6%) 46.8 [45.9–48.0] 24.4 ± 2.8 117 ± 13 76 ± 10 106 ± 30 1.29 [0.85–2.00] 203 ± 37 127 ± 33 52 ± 13 137 [92–201] 5.5 ± 1.2 9.3 ± 0.3 3.48 ± 0.43 0.78 ± 0.05 107.1 [106.2–107.8] 0.06 [0.03–0.12] 91 (15.8%) 144 (25.0%) 275 (47.7%) 18 [8–36] 148 (31.7%)
0.008
