Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus
Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus
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DOI：
10.1001/jama.289.24.3273
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发表时间：
2003-06-25
影响因子：
120.7
通讯作者：
Hsu, CY
中科院分区：
文献类型：
--
作者：
Kramer, HJ;Nguyen, QD;Hsu, CY
背景2型糖尿病（DM）的肾脏疾病比1型糖尿病更具有异质性. 2型糖尿病患者的肾小球滤过率（GFR）降低可能并不总是由于典型的糖尿病肾小球硬化所致，后者与白蛋白尿和视网膜病变有关。定义为GFR小于60 mL/min/1.73 m2体表面积（BSA）在没有微量白蛋白尿或大量白蛋白尿和糖尿病视网膜病变的2型糖尿病成人中。设计，设置，第三次全国健康和营养检查调查中40岁或以上2型糖尿病成人的横断面分析，从1988- 1994年对美国非住院平民总人口进行概率抽样。主要结果测量每1.73 m2 BSA的GFR，使用肾脏疾病饮食改良研究预测方程，用血清肌酐、尿素氮和血清白蛋白水平计算;白蛋白尿，使用现货尿白蛋白/肌酐比值评估;和视网膜病变的存在，确定与fundus photographing.Results总体而言，13%（抽样n=171）的成人2型糖尿病（n=1197）有CRI的人口估计为110万。在这些患有CRI的成人中，糖尿病视网膜病变的发生率为28%（n=58），而微量白蛋白尿和大量白蛋白尿的发生率分别为45%（n=64）和19%（n=47）。视网膜病变和蛋白尿（微量白蛋白尿或大量白蛋白尿）均不存在于30%（n=51）的成人2型糖尿病和CRI。在没有糖尿病视网膜病变或蛋白尿的情况下，2型糖尿病和CRI成人的人口估计约为0.3万。结论在美国2型糖尿病患者中，CRI的重大负担可能是由于肾实质疾病而不是经典的糖尿病肾小球硬化。在2型DM人群中筛查肾脏疾病的方法除了监测尿白蛋白排泄和眼底镜变化外，还应包括GFR评估，以确保患有2型DM和非糖尿病肾小球硬化CRI的个体将接受适当的干预。
Context Kidney disease in type 2 diabetes mellitus (DM) is more heterogeneous than in type 1 DM. Reduced glomerular-filtration rate (GFR) among individuals with type 2 DM may not always be due to classic diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy.Objective To determine the prevalence of chronic renal insufficiency (CRI), defined as a GFR less than 60 mL/min per 1.73 m(2) body surface area (BSA) in the absence of microalbuminuria or macroalbuminuria and diabetic retinopathy among adults with type 2 DM.Design, Setting, and Participants Cross-sectional analysis of adults aged 40 years or older with type 2 DM in the Third National Health and Nutrition Examination Survey, a probability sample of the total civilian US non institutionalized population conducted from 1988-1994.Main Outcome Measures The GFR per 1.73 m(2) BSA, calculated with serum creatinine, urea nitrogen, and serum albumin levels using the Modification of Diet in Renal Disease Study prediction equation; albuminuria, assessed using spot urine albumin/ creatinine ratio; and presence of retinopathy, determined with fundus photography.Results Overall, 13% (sampled n=171) of adults with type 2 DM (n=1197) had CRI with a population estimate of 1.1 million. Among these adults with CRI, diabetic retinopathy was noted in 28% (n=58), while the frequencies of microalbuminuria and macroalbuminuria were 45% (n=64) and 19% (n=47), respectively. Retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were both absent in 30% (n=51) of adults with type 2 DM and CRI. The population estimate of adults with type 2 DM and CRI in the absence of diabetic retinopathy or albuminuria was approximately 0.3 million.Conclusions A substantial burden of CRI among persons with type 2 DM in the United States is likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis. Approaches to screening renal disease in the type 2 DM population should incorporate assessment of GFR in addition to monitoring urine albumin excretion and funduscopic changes to ensure that individuals with type 2 DM and CRI not due to diabetic glomerulosclerosis will receive appropriate intervention.