Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study.
Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study.
复制标题
DOI：
10.2337/dc09-1098
复制
发表时间：
2010-07
期刊：
影响因子：
16.2
通讯作者：
Epidemiology of Diabetes Interventions and Complications Study Group
中科院分区：
文献类型：
--
作者：
Molitch ME;Steffes M;Sun W;Rutledge B;Cleary P;de Boer IH;Zinman B;Lachin J;Epidemiology of Diabetes Interventions and Complications Study Group
这项多中心研究检查了白蛋白排泄率（AER）对糖尿病干预和并发症流行病学（EDIC）研究（糖尿病控制和并发症试验[DCCT]/EDIC的平均持续时间为19年）第14年的1型糖尿病患者肾小球滤过率（eGFR）估计过程和持续eGFR <60 ml/min/1.73 m2的发生率的影响。在DCCT和EDIC研究中，从参与者收集的4小时尿液中测量尿白蛋白，分别在每年和每隔一年进行一次。在DCCT和EDIC研究中，每年测量血清肌酐。GFR由血清肌酐估算，使用肾脏疾病方程中饮食的简化修改。在DCCT/EDIC研究期间，1439名受试者中共有89人发生eGFR <60 ml/min/1.73 m2（连续两次或两次以上慢性肾脏疾病3期）（累积发病率11.4%）。其中，20人（24%）在所有先前评估中AER <30 mg/24 h， 14人（16%）在达到慢性肾病3期之前发生微量白蛋白尿（AER 30 - 300 mg/24 h）， 54人（61%）在达到慢性肾病3期之前发生大量白蛋白尿（AER 100 - 300 mg/24 h）。大量蛋白尿与eGFR下降率显著增加（AER <30 mg/24 h时为5.7%/年，而AER <30 mg/24 h时为1.2%/年，P < 0.0001）和eGFR风险<60 ml/min/1.73 m2（校正风险比15.3,P < 0.0001）相关，而微量蛋白尿对eGFR的影响较弱且不一致。巨量蛋白尿是eGFR丢失和持续eGFR <60 ml/min/1.73 m2风险的一个强有力的预测因子。然而，单独使用AER筛查会遗漏24%的持续eGFR受损病例。
This multicenter study examined the impact of albumin excretion rate (AER) on the course of estimated glomerular filtration rate (eGFR) and the incidence of sustained eGFR <60 ml/min/1.73 m2 in type 1 diabetes up to year 14 of the Epidemiology of Diabetes Interventions and Complications (EDIC) study (mean duration of 19 years in the Diabetes Control and Complications Trial [DCCT]/EDIC). Urinary albumin measurements from 4-h urine collections were obtained from participants annually during the DCCT and every other year during the EDIC study, and serum creatinine was measured annually in both the DCCT and EDIC study. GFR was estimated from serum creatinine using the abbreviated Modification of Diet in Renal Disease equation. A total of 89 of 1,439 subjects developed an eGFR <60 ml/min/1.73 m2 (stage 3 chronic kidney disease on two or more successive occasions (sustained) during the DCCT/EDIC study (cumulative incidence 11.4%). Of these, 20 (24%) had AER <30 mg/24 h at all prior evaluations, 14 (16%) had developed microalbuminuria (AER 30–300 mg/24 h) before they reached stage 3 chronic kidney disease, and 54 (61%) had macroalbuminuria (AER >300 mg/24 h) before they reached stage 3 chronic kidney disease. Macroalbuminuria is associated with a markedly increased rate of fall in eGFR (5.7%/year vs. 1.2%/year with AER <30 mg/24 h, P < 0.0001) and risk of eGFR <60 ml/min/1.73 m2 (adjusted hazard ratio 15.3, P < 0.0001), whereas microalbuminuria had weaker and less consistent effects on eGFR. Macroalbuminuria was a strong predictor of eGFR loss and risk of developing sustained eGFR <60 ml/min/1.73 m2. However, screening with AER alone would have missed 24% of cases of sustained impaired eGFR.
登录
查看更多内容
影响因子：
16.2
作者：
MacIsaac, R;Tsalamandris, C;Jerums, G
通讯作者：
Jerums, G
影响因子：
13.2
作者：
Costacou, Tina;Ellis, Demetrius;Orchard, Trevor J.
通讯作者：
Orchard, Trevor J.
影响因子：
7.7
作者：
TSALAMANDRIS, C;ALLEN, TJ;JERUMS, G
通讯作者：
JERUMS, G
影响因子：
7.7
作者：
Caramori, ML;Fioretto, P;Mauer, M
通讯作者：
Mauer, M
影响因子：
13.6
作者：
Perkins, Bruce A.;Ficociello, Linda H.;Krolewski, Andrzej S.
通讯作者：
Krolewski, Andrzej S.