Diabetes Mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004
Diabetes Mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004
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DOI：
10.1053/j.ajkd.2007.12.013
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发表时间：
2008-04-01
影响因子：
13.2
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Whaley-Connell, Adam T.;Sowers, James R.;Collins, Allan J.
背景：糖尿病是慢性肾脏疾病（CKD）的主要原因，并导致CKD人群的发病率和死亡率增加。通过有针对性的筛查项目进行早期糖尿病识别对于制定预防策略非常重要。方法：对美国国家肾脏基金会肾脏早期评估项目（KEEP）数据和美国国家健康与营养与检查调查（NHANES） 1999-2004年数据进行横断面分析。KEEP是一个以社区为基础的健康筛查项目，招募18岁或以上患有糖尿病、高血压或有肾脏疾病、糖尿病或高血压家族史的个人。研究参与者是那些符合这些纳入标准的人。接受过肾脏移植或目前正在接受透析治疗的参与者被排除在外。结果：73,460名KEEP参与者中，20,562名（28.0%）患有糖尿病，而17,049名NHANES参与者中有1,545名（6.7%）患有糖尿病。年龄、肥胖、高胆固醇水平、高血压和心血管疾病分布在这两个人群中相似，而女性和非裔美国人在KEEP中比例过高。KEEP患者的糖尿病患病率随着CKD分期的增加而逐渐增加，并且这种关系在老年参与者的亚组分析（年龄0 ~ 46岁）中持续存在，也在按性别、种族和其他CKD危险因素分层的分析中持续存在：当前的烟草使用、肥胖、高血压、心血管疾病和胆固醇水平升高。KEEP试验中报告患有糖尿病的CKD患者不太可能达到目标血糖水平（优势比0.71；95%可信区间0.66 ~ 0.77;P < 0.001）。报告无糖尿病与血糖水平升高的可能性相关(优势比为1.28；95%可信区间为1。16 - 1.41；P < 0.001)。结论：关于CKD患者糖尿病患病率较高，KEEP与NHANES一致。作为一项有针对性的筛查计划，KEEP可能代表更高的风险和更积极的患者群体。
Background: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and contributes to increased morbidity and mortality in the CKD population. Early diabetes identification through targeted screening programs is important for the development of preventive strategies.Methods: This is a cross-sectional analysis of the National Kidney Foundation Kidney Early Evaluation Program (KEEP) data and National Health and Nutrition and Examination Survey (NHANES) 1999-2004 data. KEEP is a community-based health-screening program enrolling individuals 18 years or older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. Study participants were those identified as meeting these inclusion criteria. Participants who had received kidney transplants or were currently receiving dialysis therapy were excluded.Results: Of 73,460 KEEP participants, 20,562 (28.0%) had diabetes compared with 1,545 of 17,049 (6.7%) NHANES participants. Age, obesity, high cholesterol level, hypertension, and cardiovascular disease distributions were similar for patients with diabetes in both populations, whereas women and African Americans were overrepresented in KEEP. The prevalence of diabetes in KEEP progressively increased with increasing stage of CKD, and this relationship persisted in subgroup analyses of older participants (age > 46 years), as well as in analyses stratified by sex, race, and other CKD risk factors: current tobacco use, obesity, hypertension, cardiovascular disease, and increased cholesterol level. KEEP participants with CKD who reported having diabetes were unlikely to have met target blood glucose levels (odds ratio, 0.71; 95% confidence interval, 0.66 to 0.77; P < 0.001). Reporting not having diabetes was associated with the likelihood of increased blood glucose levels (odds ratio, 1.28; 95% confidence interval, 1. 16 to 1.41; P < 0.001).Conclusion: KEEP is congruent with NHANES regarding a greater prevalence of diabetes in patients with CKD. As a targeted screening program, KEEP may represent a higher risk and more motivated patient population.