Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes - Effect of diabets duration, A1C, hypertension, dyslipedemia, diabets onset, and sex
Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes - Effect of diabets duration, A1C, hypertension, dyslipedemia, diabets onset, and sex
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DOI：
10.2337/dc07-0282
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发表时间：
2007-10-01
期刊：
影响因子：
16.2
通讯作者：
Holl, Reinhard W.
中科院分区：
文献类型：
--
作者：
Raile, Klemens;Galler, Angela;Holl, Reinhard W.
研究设计与方法：本研究纳入了德国糖尿病文献系统全国范围内的27,805名患者，这些患者主要是儿科和青少年发病。纳入标准是至少两个有相同分类的书面尿液分析。前瞻性记录尿液分析、治疗方案、糖尿病并发症和危险因素。基线特征是确诊时的年龄为9.94岁(中位数为5.8-14.3)，最后一次就诊的年龄为16.34岁(12.5-22.2)，随访时间为2.5年(0.43-5.3)。用Kaplan-Meier分析检验肾病累积发生率，用Logistic回归分析与危险因素相关。结果肾病分为正常组26,605例，微量白蛋白尿组919例，大量白蛋白尿组78例，终末期肾病(ESRD)组203例。计算糖尿病病程40年后，25.4%(95%可信区间22.3-28.3)有微量白蛋白尿，9.4%(8.3-11.4)有大量白蛋白尿或终末期肾病。微量白蛋白尿的危险因素是糖尿病病程(优势比1.033，P<；0.0001)、低密度脂蛋白胆固醇(1.003，P<；0.0074)、低密度脂蛋白胆固醇(1.003，P<；0.0074)和血压(1.008，P<；0.0074)，而儿童糖尿病起病(1.011，P<；0.0001)是保护性因素。男性与大量白蛋白尿相关。结论糖尿病病程、AIC、血脂异常、血压和男性是肾病的危险因素。因此，除了尽可能好的代谢控制，对于I型糖尿病患者来说，早期诊断和及时治疗血脂异常和高血压是强制性的。
OBJECTIVE - To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease.RESEARCH DESIGN AND METHODS - A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8-14.3]), age at last visit 16.34 years (12.5-22.2), and follow-up time 2.5 years (0.43-5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression.RESULTS - Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3-28.3) had microalburninuria and 9.4% (8.3-11.4) had macroalburninuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), Al C (1.13, P < 0.0001), LDL cholesterol (1.003, P < 0.0074), and blood pressure (1.008, P < 0.0074), while childhood diabetes onset (1.0 11, P < 0.0001) was protective. Male sex was associated with the development of macroalburninuria.CONCLUSIONS - Diabetes duration, AIC, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipiderma and hypertension is mandatory in patients with type I diabetes.