Association Between Serum ?-Glutamyltransferase And Chronic Kidney Disease:a Prospective Cohort Study

ObjectiveIn recent decades,the prevalence of chronic kidney disease(CKD)continuously rises,and it has received wide attention as a global public health problem.But the awareness of CKD is still low among patients and health care providers.Milder CKD affects 5-7%of the world population and is more common in developing countries and disadvantaged populations.A nationwide epidemiological cross-sectional survey showed that the prevalence of CKD was 10.8%in China.Early detection and treatment of CKD using readily available,inexpensive therapies can slow or prevent progression to end-stage renal disease(ESRD).Serum GGT has been traditionally used as an indicator of alcohol intake or liver dysfunction.Elevated serum GGT is proposed as an early and sensitive marker of oxidative stress.Prevention of CKD should be considered in planning an oxidative stress is prevalent in CKD patients and is considered to be an important driver of CKD progression and its complications.Previous studies have shown elevated GGT levels were significant predictors of hypertension,diabetes,cardiovascular disease.Reactive oxygen species(ROS)are the most important contributor of oxidative stress in biological systems.Increased limited numbers of literatures have focused on the association between ?-glutamyltransferase(GGT)and chronic kidney disease(CKD),and their results were controversial.Therefore,in this study,we set up a large-scale cohort of Chinese population to discover and verify the association between serum GGT and CKD.MethodsBased on the 2005-2010 year Shandong multicenter health management longitudinal monitoring cohort database,a longitudinal physical examination monitoring cohort was established,and we used multivariate Cox regression model to clarify whether elevated serum GGT increased the risk of CKD or not.Results1.During the follow-up of 57,891 person-years,1456 patients developed CKD,giving rise to an incidence density of 25.15 per 1000 person-years(1456/57,891 personyears).2.Under different serum GGT grades,most of the physical indicators were statistically different;3.In order to estimate 5-year cumulative CKD incidence accurately in different baselines,subjects were divided into different subgroups according to age,BMI level,hypertension and diabetes.The results showed that all the sub-groups were statistically significant in the 5-year cumulative CKD incidence,except the diabetic subgroup.4.After multiariable Cox proportional hazards regression analysis were adjusted for a variety of potential confounding factors,such as age,gender,serum creatinine,body mass index,serum albumin,glutamic acid transaminase,hemoglobin,white blood cell count,liver cholesterol,triglycerides,high blood pressure,diabetes,cardiovascular disease,smoking,drinking,we found that serum GGT is an independent risk factors for CKD.5.After gender stratification,it was found that the association between serum GGT and CKD was sex-specific.For males in the 4th quartile,CKD risk was signifcantly increased(adjusted HR,1.346(1.028-1.764),P = 0.031),and the increasing trend can also be found(P for trend=0.002).The results were consistent for log-transformed GGT(adjusted HR,1.625(1.237-2.133),P<0.001).But there was no association between increasing GGT levels and CKD among females(P for trend=0.226 for categorical analysis,P = 0.428 for log-transformed GGT).ConlusionsThe result reveals that there is a positive relationship between increasing serum GGT levels and the incidence of CKD which suggests that elevated GGT level could be an independent indicator for risk of CKD.