Although cellular and animal models have suggested a protective effect of ketone bodies (KBs), clinical data are still lacking to support these findings. This study aimed to investigate the association of KB levels with incident chronic kidney disease (CKD) and death. This was a prospective cohort study of 87,899 UK Biobank participants without baseline CKD who had plasma levels of β-hydroxybutyrate, acetoacetate, and acetone levels measured at the time of enrollment. The main predictor was plasma total KB, which was the sum of the aforementioned three KBs. The primary outcome was a composite of incident CKD, or all-cause mortality. Secondary outcomes included the individual components of the primary outcome. During a median follow-up of 11.9 years, a total of 8,145 primary outcome events occurred (incidence rate 8.0/1,000 person-years). In the multivariable Cox model, a 1-standard deviation increase in log total KB was associated with a 7 % [adjusted hazard ratio (aHR), 1.07; 95 % confidence interval (CI), 1.05–1.10] higher risk of the primary outcome. When stratified into quartiles, the aHR (95 % CI) for Q4 versus Q1 was 1.18 (1.11–1.27). This association was consistent for incident CKD (aHR, 1.04; 95 % CI, 1.01–1.07), and all-cause mortality (aHR, 1.10; 95 % CI, 1.07–1.13). Compared with Q1, Q4 was associated with a 12 % (aHR 1.12; 95 % CI 1.02–1.24) and 26 % (aHR 1.26; 95 % CI 1.15–1.37) higher risk of incident CKD and all-cause mortality, respectively. Higher KB levels were independently associated with higher risk of incident CKD and death.

中文翻译：

---

酮体与 CKD 事件和死亡的关联：英国生物银行的一项研究

尽管细胞和动物模型表明酮体（KB）具有保护作用，但仍缺乏临床数据支持这些发现。本研究旨在调查 KB 水平与慢性肾病 (CKD) 和死亡的关系。这是一项前瞻性队列研究，研究对象为 87,899 名没有基线 CKD 的英国生物银行参与者，他们在入组时测量了血浆 β-羟基丁酸、乙酰乙酸和丙酮水平。主要预测因子是血浆总 KB，即上述三个 KB 的总和。主要结局是 CKD 事件或全因死亡率的综合结果。次要结果包括主要结果的各个组成部分。在中位随访 11.9 年期间，总共发生了 8,145 起主要结局事件（发病率为 8.0/1,000 人年）。在多变量 Cox 模型中，对数总 KB 增加 1 个标准差与 7% 相关[调整后的风险比 (aHR)，1.07； 95% 置信区间 (CI)，1.05–1.10] 主要结局风险较高。当分层为四分位数时，Q4 与 Q1 的 aHR (95% CI) 为 1.18 (1.11–1.27)。这种关联与 CKD 事件（aHR，1.04；95% CI，1.01-1.07）和全因死亡率（aHR，1.10；95% CI，1.07-1.13）一致。与 Q1 相比，Q4 的 CKD 事件风险和全因死亡率分别升高 12%（aHR 1.12；95% CI 1.02–1.24）和 26%（aHR 1.26；95% CI 1.15–1.37）。较高的 KB 水平与较高的 CKD 事件和死亡风险独立相关。