Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes
Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes
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DOI：
10.2337/dc19-1438
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发表时间：
2020-01-01
期刊：
影响因子：
16.2
通讯作者：
Shaw, Jonathan E.
中科院分区：
文献类型：
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作者：
Buyadaa, Oyunchimeg;Magliano, Dianna J.;Shaw, Jonathan E.
目的：我们的目的是研究非白蛋白尿型慢性肾脏病（CKD）进展为终末期肾脏病（ESKD）或死亡或主要心血管事件（MACE）的发生率，并与白蛋白尿型和非白蛋白尿型表型进行比较。研究设计和方法我们纳入了10,185名参加控制糖尿病心血管风险行动（雅阁）研究的2型糖尿病患者。根据基线白蛋白尿和估计的肾小球滤过率（eGFR），将参与者分类为无肾脏疾病（无CKD）、仅白蛋白尿（白蛋白尿非CKD）、仅eGFR降低（非白蛋白尿CKD）或白蛋白尿和eGFR降低（白蛋白尿CKD）。计算eGFR下降率和ESKD或死亡或MACE的风险比（HR）。结果对于无慢性肾病和非蛋白尿慢性肾病的个体，eGFR下降率分别为-1.31和-0.60mL/min/年（P < 0.001）。在竞争风险分析中（无CKD作为参考），ESKD的HR表明非白蛋白尿性CKD的风险未增加（0.76 [95% CI 0.34，1.70]），而白蛋白尿性CKD的风险最大（4.52 [2.91，7.01]）。在校正的考克斯模型中，白蛋白尿CKD的死亡和MACE的HR最高（分别为2.38 [1.92，2.90]和2.37 [1.89，2.97]），白蛋白尿非CKD组更高非白蛋白尿性CKD患者的平均尿蛋白水平（分别为1.82 [1.59，2.08]和1.88 [1.63，2.16]）高于非白蛋白尿性CKD患者（分别为1.42 [1.14，1.78]和1.44 [1.13，1.84]）。结论：非白蛋白尿性CKD患者eGFR下降速度比其他任何一组慢;然而，这些患者的死亡和MACE风险仍高于非CKD患者。
OBJECTIVE We aimed to investigate the rate of progression of nonalbuminuric chronic kidney disease (CKD) to end-stage kidney disease (ESKD) or death or major cardiovascular events (MACE) compared with albuminuric and nonalbuminuric phenotypes. RESEARCH DESIGN AND METHODS We included 10,185 participants with type 2 diabetes enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Based on baseline albuminuria and estimated glomerular filtration rate (eGFR), participants were classified as having no kidney disease (no CKD), albuminuria only (albuminuric non-CKD), reduced eGFR only (nonalbuminuric CKD), or both albuminuria and reduced eGFR (albuminuric CKD). The rate of eGFR decline and hazard ratios (HRs) for ESKD or death or MACE were calculated. RESULTS For individuals with no CKD and those with nonalbuminuric CKD, the rates of eGFR decline were -1.31 and -0.60 mL/min/year, respectively (P < 0.001). In competing-risks analysis (no CKD as the reference), HRs for ESKD indicated no increased risk for nonalbuminuric CKD (0.76 [95% CI 0.34, 1.70]) and greatest risk for albuminuric CKD (4.52 [2.91, 7.01]). In adjusted Cox models, HRs for death and MACE were highest for albumuniuric CKD (2.38 [1.92, 2.90] and 2.37 [1.89, 2.97], respectively) and were higher for albuminuric non-CKD (1.82 [1.59, 2.08] and 1.88 [1.63, 2.16], respectively) than for those with nonalbuminuric CKD (1.42 [1.14, 1.78] and 1.44 [1.13, 1.84], respectively). CONCLUSIONS Those with nonalbuminuric CKD showed a slower rate of decline in eGFR than did any other group; however, these individuals still carry a greater risk for death and MACE than do those with no CKD.