Diverging association of reduced glomerular filtration rate and albuminuria with coronary and noncoronary events in patients with type 2 diabetes: the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study.
Diverging association of reduced glomerular filtration rate and albuminuria with coronary and noncoronary events in patients with type 2 diabetes: the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study.
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DOI：
10.2337/dc11-1380
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发表时间：
2012-01
期刊：
影响因子：
16.2
通讯作者：
Renal Insufficiency And Cardiovascular Events (RIACE) Study Group
中科院分区：
文献类型：
--
作者：
Solini A;Penno G;Bonora E;Fondelli C;Orsi E;Arosio M;Trevisan R;Vedovato M;Cignarelli M;Andreozzi F;Nicolucci A;Pugliese G;Renal Insufficiency And Cardiovascular Events (RIACE) Study Group
尽管估计肾小球滤过率(EGFR)降低被证明是心血管疾病(CVD)的一个强大的独立预测因子，但其他研究表明，它的风险比单独蛋白尿低得多，而这两种异常的组合与乘性风险相关。这项研究旨在评估既往心血管事件与EGFR、蛋白尿和慢性肾脏疾病(CKD)表型的独立相关性，无论是总体的还是血管床上的。这项横断面研究评估了2007-2008年间19个门诊糖尿病诊所的15,773名2型糖尿病患者，这些患者来自意大利的肾功能不全和心血管事件(RIACE)多中心研究。蛋白尿通过免疫比浊法或免疫比浊法进行评估。肾小球滤过率通过简化的肾脏疾病饮食调整研究和慢性肾脏疾病-流行病学协作方程来估计。慢性肾功能不全定义为60毫升/分钟/1.73米~2或微量或大量白蛋白尿。根据出院记录或专科医生就诊来判定重大急性心血管事件。心血管风险随肾小球滤过率的下降和蛋白尿的增加而线性增加，并分别以78毫升/分钟/1.73m~2和≥10.5 mg/24 h的数值显著。除传统的心血管危险因素外，总心血管疾病与单纯蛋白尿(优势比1.20[95%可信区间1.08~1.33])、单纯EGFR降低(1.52[1.34~1.73])、两种异常(1.90[1.66~2.19])均独立相关。然而，冠状动脉事件主要与EGFR降低有关，而脑血管和外周事件与蛋白尿型CKD表型有更强的相关性。这些数据虽然是横断面的，但表明无论蛋白尿如何，EGFR降低都与显著的心血管疾病有关，尤其是在冠脉区。
Although a reduced estimated glomerular filtration rate (eGFR) was shown to be a powerful independent predictor of cardiovascular disease (CVD), other studies suggested that it confers a much lower risk than albuminuria alone, whereas the combination of the two abnormalities is associated with multiplicative risk. This study aimed at assessing the independent association of previous CVD events, either total or by vascular bed, with eGFR and albuminuria and chronic kidney disease (CKD) phenotypes. This cross-sectional study evaluated 15,773 patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study in 19 outpatient diabetes clinics in years 2007–2008. Albuminuria was assessed by immunonephelometry or immunoturbidimetry. GFR was estimated by the simplified Modification of Diet in Renal Disease Study and the Chronic Kidney Disease-Epidemiology Collaboration equation. CKD was defined as an eGFR <60 mL/min/1.73 m2 or micro- or macroalbuminuria. Major acute CVD events were adjudicated based on hospital discharge records or specialist visits. CVD risk increased linearly with eGFR decline and albuminuria and became significant for values <78 mL/min/1.73 m2 and ≥10.5 mg/24 h, respectively. Beyond traditional CVD risk factors, total CVD showed an independent association with albuminuria alone (odds ratio 1.20 [95% CI 1.08–1.33]), reduced eGFR alone (1.52 [1.34–1.73]), and both abnormalities (1.90 [1.66–2.19]). However, coronary events were associated predominantly with reduced eGFR alone, whereas cerebrovascular and peripheral events showed a stronger correlation with the albuminuric CKD phenotypes. These data, although cross-sectional, show that reduced eGFR, irrespective of albuminuria, is associated with significant CVD, particularly in the coronary district.
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影响因子：
8.3
作者：
Bos, Michiel J.;Koudstaal, Peter J.;Breteler, Monique M. B.
通讯作者：
Breteler, Monique M. B.
影响因子：
13.6
作者：
Kramer, H;Toto, R;Victor, R
通讯作者：
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影响因子：
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Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
8.2
作者：
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通讯作者：
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影响因子：
4.9
作者：
Hermansa, Marc M. H.;Henry, Ronald M. A.;Stehouwer, Coen D. A.
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Stehouwer, Coen D. A.