Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP).
Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP).
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DOI：
10.1186/1471-2369-13-104
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发表时间：
2012-09-07
期刊：
影响因子：
2.3
通讯作者：
KEEP investigators
中科院分区：
文献类型：
--
作者：
Bose S;Bomback AS;Mehta NN;Chen SC;Li S;Whaley-Connell A;Benjamin J;McCullough PA;KEEP investigators
慢性肾脏病(CKD)合并糖尿病(DM)患者的血糖控制和血脂异常与尿白蛋白/肌酐(ACR)的关系尚不清楚。我们试图在国家肾脏基金会(NKF)肾脏早期评估计划(KEEP)中调查糖尿病和慢性肾脏病(CKD)3期或更高的参与者中血脂异常和血糖控制与蛋白尿水平的关系。从2008年6月到2009年12月，我们对6639名符合条件的糖尿病和慢性肾脏病3-5期患者进行了横断面研究。用多因素Logistic回归分析血脂参数(每改变10 mg/dl)和糖化血红蛋白(HbA1c)与正常白蛋白尿(30 mg⁄g)、微量白蛋白尿(30~300 mg⁄g)和大量白蛋白尿(300 mg⁄g)的关系。2141名Keep参与者包括在内。HbA1c水平与微量白蛋白尿(与正常白蛋白尿相比)和大量白蛋白尿(与正常白蛋白尿和微量白蛋白尿相比)密切相关。HbA1c每升高1.0%，发生微量白蛋白尿的几率增加32%(OR1.32，95%可信区间1.23~1.42)，发生大量白蛋白尿的几率增加16%(OR1.16，95%可信区间1.05~1.28)。只有血清高密度脂蛋白升高与微量白蛋白尿的几率降低相关；否则，血脂谱的其他成分与尿ACR之间的关联没有达到统计学意义。在这项对2141名糖尿病和慢性肾脏病患者的横断面研究中，总体血糖控制而不是血脂与尿白蛋白排泄异常相关，尿白蛋白排泄异常是进展性疾病风险增加的标志。
The relationship between glycemic control and lipid abnormalities with urinary albumin-creatinine ratio (ACR) in chronic kidney disease (CKD) patients with diabetes mellitus (DM) is unknown. We sought to investigate the association of dyslipidemia and glycemic control with levels of albuminuria in the National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) participants with DM and CKD stage 3 or higher. We performed a cross-sectional study of 6639 eligible KEEP patients with DM and CKD Stage 3 to 5 from June 2008 to December 2009. Multivariate logistic regression was used to evaluate the association of lipid parameters (per 10 mg/dl change in serum level) and glycosylated hemoglobin (HbA1c) values with three degrees of albuminuria normo (<30 mg⁄g), micro (30 to 300 mg⁄g) and macro (>300 mg⁄g). 2141 KEEP participants were included. HbA1c levels were strongly associated with micro-albuminuria (compared to normo-albuminuria) and macro-albuminuria (compared to normo-albuminuria and micro-albuminuria). Each 1.0% increase in HbA1c increased the odds of micro-albuminuria by 32% (OR 1.32, 95% CI 1.23-1.42) and the odds of macro-albuminuria (vs. microalbuminuria) by 16% (OR 1.16, 95% CI 1.05-1.28). Only increases in serum HDL were associated with decreased odds of micro-albuminuria; otherwise, the association between other components of the serum lipid profile with urinary ACR did not reach statistical significance. In this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3–5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease.