Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)
Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)
复制标题
DOI：
10.1046/j.1523-1755.2003.00712.x
复制
发表时间：
2003-01-01
影响因子：
19.6
通讯作者：
Holman, RR
中科院分区：
文献类型：
--
作者：
Adler, AI;Stevens, RJ;Holman, RR
背景。从诊断为2型糖尿病开始肾病的进展尚未在单一人群中得到很好的描述。本研究旨在描述微量白蛋白尿、大量白蛋白尿、持续升高的血浆肌酐或肾脏替代治疗（RRT）和死亡的发展和进展。使用英国前瞻性糖尿病研究中5097名受试者的观察和建模数据，我们测量了从一个阶段到另一个阶段（发病率）的年概率、患病率、累积发病率、10年生存率、每个阶段的中位持续时间以及全因或心血管疾病死亡的风险。从糖尿病诊断开始，发展为微量白蛋白尿的发生率为每年2.0%，从微量白蛋白尿到大量白蛋白尿的发生率为每年2.8%，从大量白蛋白尿到血浆肌酐升高（大于或等于175 μ mol/L）或肾脏替代治疗的发生率为每年2.3%。诊断糖尿病10年后，微量白蛋白尿的患病率为24.9%，大量白蛋白尿的患病率为5.3%，血浆肌酐或RRT升高的患病率为0.8%。血浆肌酐升高或RRT患者的年死亡率为19.2%（95%可信区间，CI, 14.0 ~ 24.4%）。随着肾病的加重，心血管死亡风险有增加的趋势（P < 0.0001），无肾病阶段受试者的年死亡率为0.7%，微量白蛋白尿组为2.0%，大量白蛋白尿组为3.5%，血浆肌酐或RRT升高组为12.1%。有大量蛋白尿的个体在任何年份死亡的可能性都大于发生肾衰竭的可能性。2型糖尿病患者发生微量白蛋白尿的比例很大，其中四分之一在诊断后10年内发病。发生大量蛋白尿的患者相对较少，但在发生大量蛋白尿的患者中，死亡率超过恶化肾病的进展率。
Background. The progression of nephropathy from diagnosis of type 2 diabetes has not been well described from a single population. This study sought to describe the development and progression through the stages of microalbuminuria, macroalbuminuria, persistently elevated plasma creatinine or renal replacement therapy (RRT), and death.Methods. Using observed and modeled data from 5097 subjects in the UK Prospective Diabetes Study, we measured the annual probability of transition from stage to stage (incidence), prevalence, cumulative incidence, ten-year survival, median duration per stage, and risk of death from all-causes or cardiovascular disease.Results. From diagnosis of diabetes, progression to microalbuminuria occurred at 2.0% per year, from microalbuminuria to macroalbuminuria at 2.8% per year, and from macroalbuminuria to elevated plasma creatinine (greater than or equal to175 mumol/L) or renal replacement therapy at 2.3% per year. Ten years following diagnosis of diabetes, the prevalence of microalbuminuria was 24.9%, of macroalbuminuria was 5.3%, and of elevated plasma creatinine or RRT was 0.8%. Patients with elevated plasma creatinine or RRT had an annual death rate of 19.2% (95% confidence interval, CI, 14.0 to 24.4%). There was a trend for increasing risk of cardiovascular death with increasing nephropathy (P < 0.0001), with an annual rate of 0.7% for subjects in the stage of no nephropathy, 2.0% for those with microalbuminuria, 3.5% for those with macroalbuminuria, and 12.1% with elevated plasma creatinine or RRT. Individuals with macroalbuminuria were more likely to die in any year than to develop renal failure.Conclusions. The proportion of patients with type 2 diabetes who develop microalbuminuria is substantial with one quarter affected by 10 years from diagnosis. Relatively fewer patients develop macroalbuminuria, but in those who do, the death rate exceeds the rate of progression to worse nephropathy.