Temporal trends in the prevalence of diabetic kidney disease in the United States.
Temporal trends in the prevalence of diabetic kidney disease in the United States.
复制标题
美国糖尿病肾病患病率的时间趋势。
DOI：
10.1001/jama.2011.861
复制
发表时间：
2011-06-22
影响因子：
120.7
通讯作者：
Himmelfarb, Jonathan
中科院分区：
文献类型：
--
作者：
de Boer, Ian H.;Rue, Tessa C.;Hall, Yoshio N.;Heagerty, Patrick J.;Weiss, Noel S.;Himmelfarb, Jonathan
糖尿病是发达国家肾脏疾病的主要原因。随着时间的推移，糖尿病肾病（DKD）的患病率可能由于糖尿病人群规模的扩大而增加，也可能由于糖尿病治疗的实施而减少。定义美国DKD患病率的时间变化。第三次全国健康与营养调查（NHANES III） 1988-1994年（N= 15073）、NHANES 1999-2004年（N= 13045）和NHANES 2005-2008年（N=9588）的横断面分析。糖尿病患者的定义是血红蛋白A1c水平达到6.5%或更高，使用降糖药物，或两者兼而有之（NHANES III中n = 1431； NHANES 1999-2004中n = 1443； NHANES 2005-2008中n = 1280）。糖尿病肾病被定义为伴有蛋白尿（尿白蛋白与肌酐比值为30mg /g）、肾小球滤过率受损（根据慢性肾病流行病学协作公式估计< 60ml /min/1.73 m2）或两者兼有的糖尿病。调整蛋白尿患病率以估计持续性蛋白尿。美国人群中DKD的患病率在NHANES III中为2.2%(95%可信区间[CI]， 1.8%-2.6%)，在NHANES 1999-2004中为2.8% (95% CI, 2.4%-3.1%)，在NHANES 2005-2008中为3.3% (95% CI, 2.8% - 3.7%)（趋势P< 0.001）。DKD患病率与糖尿病患病率成正比增加，糖尿病患者中DKD患病率没有变化。在糖尿病患者中，降糖药物的使用从NHANES III的56.2% （95% CI, 52.1%-60.4%）增加到NHANES 2005-2008的74.2% (95% CI, 70.4%-78.0%) (P<.001)；肾素-血管紧张素-醛固酮系统抑制剂的使用分别从11.2% （95% CI, 9.0%-13.4%）增加到40.6% (95% CI, 37.2%-43.9%) (P< 0.001)；肾小球滤过率受损的患病率分别从14.9% （95% CI, 12.1% ~ 17.8%）增加到17.7% (95% CI, 15.2% ~ 20.2%) (P= 0.03)；蛋白尿患病率分别从27.3% （95% CI, 22.0% ~ 32.7%）降至23.7% (95% CI, 19.3% ~ 28.0%)，但差异无统计学意义（P= 0.07）。从1988年到2008年，美国DKD患病率与糖尿病患病率成比例上升。在糖尿病患者中，尽管增加了降糖药物和肾素-血管紧张素-醛固酮系统抑制剂的使用，DKD的患病率仍保持稳定。
Diabetes is the leading cause of kidney disease in the developed world. Over time, the prevalence of diabetic kidney disease (DKD) may increase due to the expanding size of the diabetes population or decrease due to the implementation of diabetes therapies. To define temporal changes in DKD prevalence in the United States. Cross-sectional analyses of the Third National Health and Nutrition Examination Survey (NHANES III) from 1988–1994 (N = 15 073), NHANES 1999–2004 (N = 13 045), and NHANES 2005–2008 (N=9588). Participants with diabetes were defined by levels of hemoglobin A1c of 6.5% or greater, use of glucose-lowering medications, or both (n = 1431 in NHANES III; n = 1443 in NHANES 1999–2004; n = 1280 in NHANES 2005–2008). Diabetic kidney disease was defined as diabetes with albuminuria (ratio of urine albumin to creatinine >30 mg/g), impaired glomerular filtration rate (<60 mL/min/1.73 m2 estimated using the Chronic Kidney Disease Epidemiology Collaboration formula), or both. Prevalence of albuminuria was adjusted to estimate persistent albuminuria. The prevalence of DKD in the US population was 2.2% (95% confidence interval [CI], 1.8%–2.6%) in NHANES III, 2.8% (95% CI, 2.4%–3.1%) in NHANES 1999–2004, and 3.3% (95% CI, 2.8%–3.7%) in NHANES 2005–2008 (P<.001 for trend). The prevalence of DKD increased in direct proportion to the prevalence of diabetes, without a change in the prevalence of DKD among those with diabetes. Among persons with diabetes, use of glucose-lowering medications increased from 56.2% (95% CI, 52.1%–60.4%) in NHANES III to 74.2% (95% CI, 70.4%–78.0%) in NHANES 2005–2008 (P<.001); use of renin-angiotensin-aldosterone system inhibitors increased from 11.2% (95% CI, 9.0%–13.4%) to 40.6% (95% CI, 37.2%–43.9%), respectively (P<.001); the prevalence of impaired glomerular filtration rate increased from 14.9% (95% CI, 12.1%–17.8%) to 17.7% (95% CI, 15.2%–20.2%), respectively (P=.03); and the prevalence of albuminuria decreased from 27.3% (95% CI, 22.0%–32.7%) to 23.7% (95% CI, 19.3%–28.0%), respectively, but this was not statistically significant (P=.07). Prevalence of DKD in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes. Among persons with diabetes, prevalence of DKD was stable despite increased use of glucose-lowering medications and renin-angiotensin-aldosterone system inhibitors.
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