Risk factors of proteinuria in hypertensive people living at high altitude for generations

doi:10.3969/j.issn.1004-583X.2023.12.005

Abstract

Abstract:

Objective To investigate the incidence and related risk factors of proteinuria in hypertensive patients living at high altitude for generations. Methods The clinical data of hypertension patients over 18 years old admitted in the internal medicine ward of Nangqian People's Hospital in Yushu Tibetan Autonomous Prefecture of Qinghai Province from January 2017 to March 2023 were retrospectively analyzed. The patients were assigned into albuminuria group and non-albuminuria group according to the level of proteinuria. The differences of baseline demographic characteristics, blood pressure, and 24-hour laboratory examination indexes after admission between groups were compared, and multivariate logistic regression analysis was performed to explore the risk factors of proteinuria in patients with hypertension at high altitude. Results A total of 695 patients with hypertension representing 148 in albuminuria group and 547 in non-albuminuria group were enrolled in this study. Patients of albuminuria group had significantly higher proportion of men and diabetes mellitus (DM), increased levels of systolic/diastolic blood pressure (SBP/DBP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb), uric acid (UA), urea nitrogen (BUN) and serum creatinine (SCr), and had significantly decreased levels of mean age and platelets (PLT) than those of non-albuminuria group ( $P$ <0.05). Both albuminuria group and non-albuminuria group were comparable in the levels of body mass index (BMI) and high density lipoprotein cholesterol (HDL-C) ( $P$ >0.05). The total incidence of high-altitude polycythemia (HAPC) was 7.3%(51/695). The incidence of HAPC and hyperuricemia in the albuminuria group was significantly higher than that in the non-albuminuria group (16.2% vs 4.9%, 42.6% vs 30.2%, both $P$ <0.01, respectively). Multivariate Logistic regression analysis showed that DM ( $O R$ : 3.924, 95% confidence interval [ $C I$ ]: 2.208-6.973, $P$ <0.01), HAPC ( $O R$ : 2.956, 95% $C I$ : 1.486-5.880, $P$ =0.002), and elevated SCr levels ( $O R$ : 1.021, 95% $C I$ : 1.010-1.031, $P$ <0.01) were the independent associations of proteinuria. Conclusion Diabetes mellitus, HAPC and elevated SCr are significant independent associations of proteinuria in hypertensive people living at high altitude for generations.

Key words: high blood pressure, proteinuria, polycythemia, diabetes mellitus, kidney damage, plateau

CLC Number:

R544.1

Jiang Ji, Zhu Xiaogang, Jiang Shan, Dawa Zhaba, Cen Qiang. Risk factors of proteinuria in hypertensive people living at high altitude for generations[J]. Clinical Focus, 2023, 38(12): 1086-1090.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.12.005

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I12/1086

Figures/Tables 3

Tab.1 Comparison of demography and baseline in the two groups

指标	总人群( $n$ =695)	蛋白尿组( $n$ =148)	无蛋白尿组( $n$ =547)	$t$ /χ²值	$P$ 值
男性[例(%)]	307(44.2)	89(60.1)	218(39.9)	9.440	0.002
年龄(岁)	65.2±11.2	63.3±12.2	65.8±10.8	-2.260	0.009
BMI(kg/m²)	27.4±4.5	27.7±4.6	27.4±4.9	0.798	0.496
DM[例(%)]	80(11.5)	35(23.6)	45(8.2)	411.835	<0.01
SBP(mmHg)	158±26	163±27	157±25	2.273	0.024
DBP(mmHg)	97±16	100±18	96±15	2.375	0.018
WBC(×10⁹/L)	6.5±2.1	6.9±2.5	6.4±2.0	2.113	0.033
RBC(×10¹²/L)	5.5±0.9	5.8±1.1	5.4±0.8	4.796	<0.01
Hb(g/L)	161.6±26.3	172.8±29.9	158.6±24.4	5.310	<0.01
PLT(×10⁹/L)	232.2±66.5	222.6±74.3	234.8±64.0	-1.821	0.035
TC(mmol/L)	4.8±1.3	4.9±1.7	4.7±1.1	0.929	<0.01
TG(mmol/L)	1.5±0.9	1.6±1.1	1.4±0.9	1.574	0.003
LDL-C( mmol/L)	2.9±0.9	3.0±1.2	2.9±0.8	0.596	<0.01
HDL-C(mmol/L)	1.2±0.5	2.2±0.8	1.2±0.4	-0.041	0.078
UA(μmol/L)	355.5±120.0	387.9±129.8	346.7±115.8	3.503	0.049
BUN(mmol/L)	5.1±3.2	6.0±5.4	4.8±2.2	2.516	<0.01
SCr(μmol/L)	73.6±23.7	85.9±29.5	70.3±20.6	6.072	<0.01

Tab.1 Comparison of demography and baseline in the two groups

指标	总人群( $n$ =695)	蛋白尿组( $n$ =148)	无蛋白尿组( $n$ =547)	$t$ /χ²值	$P$ 值
男性[例(%)]	307(44.2)	89(60.1)	218(39.9)	9.440	0.002
年龄(岁)	65.2±11.2	63.3±12.2	65.8±10.8	-2.260	0.009
BMI(kg/m²)	27.4±4.5	27.7±4.6	27.4±4.9	0.798	0.496
DM[例(%)]	80(11.5)	35(23.6)	45(8.2)	411.835	<0.01
SBP(mmHg)	158±26	163±27	157±25	2.273	0.024
DBP(mmHg)	97±16	100±18	96±15	2.375	0.018
WBC(×10⁹/L)	6.5±2.1	6.9±2.5	6.4±2.0	2.113	0.033
RBC(×10¹²/L)	5.5±0.9	5.8±1.1	5.4±0.8	4.796	<0.01
Hb(g/L)	161.6±26.3	172.8±29.9	158.6±24.4	5.310	<0.01
PLT(×10⁹/L)	232.2±66.5	222.6±74.3	234.8±64.0	-1.821	0.035
TC(mmol/L)	4.8±1.3	4.9±1.7	4.7±1.1	0.929	<0.01
TG(mmol/L)	1.5±0.9	1.6±1.1	1.4±0.9	1.574	0.003
LDL-C( mmol/L)	2.9±0.9	3.0±1.2	2.9±0.8	0.596	<0.01
HDL-C(mmol/L)	1.2±0.5	2.2±0.8	1.2±0.4	-0.041	0.078
UA(μmol/L)	355.5±120.0	387.9±129.8	346.7±115.8	3.503	0.049
BUN(mmol/L)	5.1±3.2	6.0±5.4	4.8±2.2	2.516	<0.01
SCr(μmol/L)	73.6±23.7	85.9±29.5	70.3±20.6	6.072	<0.01

Tab.2 Comparison of the incidence of HAPC、HUA in the two groups(n[%])

组别	例数	HAPC	HUA
总人群	695	51(7.3)	228(32.8)
蛋白尿组	148	24(16.2)	63(42.6)
无蛋白尿组	547	27(4.9)	165(30.2)
$t$ /χ²值		505.970	82.188
$P$ 值		<0.01	<0.01

Tab.2 Comparison of the incidence of HAPC、HUA in the two groups(n[%])

组别	例数	HAPC	HUA
总人群	695	51(7.3)	228(32.8)
蛋白尿组	148	24(16.2)	63(42.6)
无蛋白尿组	547	27(4.9)	165(30.2)
$t$ /χ²值		505.970	82.188
$P$ 值		<0.01	<0.01

Tab.3 Multivariate Logistic regression analysis of albuminuria in hypertensive patients

指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	下限	上限
男性	0.197	0.241	0.669	0.413	1.218	0.759	1.954
年龄	-0.016	0.010	2.921	0.087	0.984	0.965	1.002
糖尿病	1.367	0.293	21.717	<0.01	3.924	2.208	6.973
SBP	0.000	0.005	0.004	0.947	1.000	0.989	1.010
DBP	0.009	0.009	1.198	0.274	1.009	0.993	1.027
WBC	0.084	0.048	3.014	0.083	1.088	0.989	1.196
PLT	-0.002	0.002	0.789	0.375	0.998	0.995	1.002
TC	0.014	0.160	0.008	0.931	1.014	0.741	1.388
TG	0.013	0.121	0.012	0.912	1.013	0.800	1.284
LDL-C	-0.052	0.219	0.057	0.811	0.949	0.618	1.457
BUN	-0.001	0.030	0.001	0.975	0.999	0.942	1.059
SCr	0.020	0.005	15.727	<0.01	1.021	1.010	1.031
HAPC	1.084	0.351	9.539	0.002	2.956	1.486	5.880
HUA	0.147	0.229	0.408	0.523	1.158	0.739	1.815
常数项	-3.285	1.150	8.164		0.037

Tab.3 Multivariate Logistic regression analysis of albuminuria in hypertensive patients

指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	95% $C I$
指标	回归系数	标准误	χ²值	$P$ 值	$O R$ 值	下限	上限
男性	0.197	0.241	0.669	0.413	1.218	0.759	1.954
年龄	-0.016	0.010	2.921	0.087	0.984	0.965	1.002
糖尿病	1.367	0.293	21.717	<0.01	3.924	2.208	6.973
SBP	0.000	0.005	0.004	0.947	1.000	0.989	1.010
DBP	0.009	0.009	1.198	0.274	1.009	0.993	1.027
WBC	0.084	0.048	3.014	0.083	1.088	0.989	1.196
PLT	-0.002	0.002	0.789	0.375	0.998	0.995	1.002
TC	0.014	0.160	0.008	0.931	1.014	0.741	1.388
TG	0.013	0.121	0.012	0.912	1.013	0.800	1.284
LDL-C	-0.052	0.219	0.057	0.811	0.949	0.618	1.457
BUN	-0.001	0.030	0.001	0.975	0.999	0.942	1.059
SCr	0.020	0.005	15.727	<0.01	1.021	1.010	1.031
HAPC	1.084	0.351	9.539	0.002	2.956	1.486	5.880
HUA	0.147	0.229	0.408	0.523	1.158	0.739	1.815
常数项	-3.285	1.150	8.164		0.037

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