Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative.
Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative.
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DOI：
10.1097/md.0000000000004007
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发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
and the AMD-Annals Study Group
中科院分区：
文献类型：
--
作者：
De Cosmo S;Viazzi F;Pacilli A;Giorda C;Ceriello A;Gentile S;Russo G;Rossi MC;Nicolucci A;Guida P;Pontremoli R;and the AMD-Annals Study Group
补充数字内容可在文本中识别慢性肾脏疾病发展的临床预测因素是2型糖尿病患者管理的关键问题。我们评估了27，029例2型糖尿病患者，估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m2，来自意大利临床糖尿病学家协会网络数据库的正常白蛋白尿。 主要结局为eGFR <60 mL/min/1.73 m2和正常白蛋白尿;白蛋白尿和eGFR ≥60 mL/min/1.73 m2; eGFR <60 mL/min/1.73 m2和白蛋白尿。 次要结局为eGFR <60 mL/min/1.73 m2和蛋白尿。 测量值：eGFR来自慢性肾脏疾病流行病学协作方程（CKD-EPI）的血清肌酐、尿白蛋白排泄、HbA 1c、甘油三酯、高密度脂蛋白胆固醇（HDL-c）和低密度脂蛋白胆固醇（LDL-c）、血压和体重指数。在4年期间，33.2%的患者（n = 8973）发展为慢性肾脏疾病，10.3%（n = 2788）显示eGFR下降<60 mL/min/1.73 m2，18.4%（n = 4978）发展为蛋白尿，4.5%（n = 1207）发展为两种特征。 年龄（1.37，5岁时P<0.001）、性别（0.77，男性时P<0.001）、体重指数（1.03，1 kg/m2时P <0.001）、甘油三酯（1.02，10 mg/dL时P<0.001）和LDL-c（0.97，10mg/dL时P = 0.004）的相对风险比（RRRs）与eGFR降低的发生独立相关。 年龄（5岁时为1.08，P <0.001）、性别（男性为1.36，P <0.001）、体重指数（1 kg/m2时为1.02，P <0.001）、甘油三酯（10 mg/dL时为1.01，P = 0.02）、HDL-c和LDL-c（5 mg/dL和10 mg/dL时分别为0.97，P = 0.008和0.99，P = 0.003）与白蛋白尿的发生有关。 HbA 1c和抗高血压治疗强度与肾脏结局的相关性较弱。eGFR和白蛋白尿的降低显示了不同的风险因素，表明糖尿病肾病这两种组分的发展涉及不同的机制。
Supplemental Digital Content is available in the text The identification of clinical predictors for the development of chronic kidney disease is a critical issue in the management of patients with type 2 diabetes mellitus. We evaluated 27,029 patients with type 2 diabetes mellitus and estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and normoalbuminuria from the database of the Italian Association of Clinical Diabetologists network. Primary outcomes were eGFR <60 mL/min/1.73 m2 and normoalbuminuria; albuminuria and eGFR ≥60 mL/min/1.73 m2; and eGFR <60 mL/min/1.73 m2 and albuminuria. Secondary outcomes were eGFR <60 mL/min/1.73 m2 and albuminuria. Measurements: eGFR from serum creatinine by chronic kidney disease epidemiology collaboration equation (CKD-EPI), urinary albumin excretion, HbA1c, triglycerides, high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c), blood pressure, and body mass index. Over a 4-year period, 33.2% of patients (n = 8973) developed chronic kidney disease, 10.3% (n = 2788) showed a decline in eGFR <60 mL/min/1.73 m2, 18.4% (n = 4978) developed albuminuria, and 4.5% (n = 1207) developed both features. Relative risk ratios (RRRs) for age (1.37, P < 0.001 by 5 years), sex (0.77, P < 0.001 for being male), body mass index (1.03, P < 0.001 by 1 kg/m2), triglycerides (1.02, P < 0.001 by 10 mg/dL), and LDL-c (0.97, P = 0.004 by 10 mg/dL) were independently related to the onset of eGFR reduction. Age (1.08, P < 0.001 by 5 years), sex (1.36, P < 0.001 for being male), body mass index (1.02, P < 0.001 by 1 kg/m2), triglycerides (1.01, P = 0.02 by 10 mg/dL), HDL-c, and LDL-c (0.97, P = 0.008 and 0.99, P = 0.003 by 5 and 10 mg/dL, respectively) were related to the onset of albuminuria. HbA1c and the intensity of antihypertensive treatment showed a weaker association with renal outcome. Reduction in eGFR and albuminuria showed distinct sets of risk factors, suggesting that different mechanisms are involved in the development of these 2 components of diabetic kidney disease.