| 总结: | <p>Introduction: Changes in urinary albumin-to-creatinine ratio (UACR) may affect the risk of advanced chronic kidney disease (CKD). How much the effect depends upon natural variation and the time period for the change is unknown.</p><p> Methods: English Clinical Practice Research Datalink records (2000-2015), with linkage to secondary care and death certification, were used to identify prospective cohorts with at least two measures of UACR within 1, 2 and 3 years. Adjusted Cox regression assessed the separate relevance of baseline UACR and UACR change to the risk of developing CKD stage 4-5 and end-stage renal disease (ESRD). Associations were compared before and after accounting for the effects of natural regression to the mean (RtM).</p><p> Results: 212,810 individuals had baseline UACR measurements; 22% had a UACR ≥3.4, and 3% had UACR ≥33.9, mg/mmol. During a median 4.0 years follow-up, 5976 developed CKD stage 4-5 and 1076 developed ESRD. There were strong associations between baseline UACR and CKD stage 4-5 or ESRD risk, which doubled in strength after accounting for RtM. Over 3 years, the hazard ratios, HRs (95%CIs) for CKD stage 4-5, relative to stable UACR, were 0.62 (0.50-0.77) for at least a halving of UACR and 2.68 (2.29-3.14) for at least a doubling. Associations were weaker for shorter exposure windows (and for cardiovascular disease or death), but strengthened after allowing for RtM.</p><p> Conclusion: Baseline values and medium term increases in albuminuria are both associated with substantially increased risk of developing advanced CKD. Standard analyses, not allowing for RtM, may underestimate these associations.</p>
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