Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease.
Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease.
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DOI：
10.1038/s41598-017-01204-6
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发表时间：
2017-04-21
影响因子：
4.6
通讯作者：
Chen HC
中科院分区：
文献类型：
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作者：
Hung CC;Lin HY;Hwang DY;Kuo IC;Chiu YW;Lim LM;Hwang SJ;Chen HC
糖尿病病程、糖尿病视网膜病变（DR）和诊断模型已被提出作为支持糖尿病肾病活检患者中存在糖尿病肾病（DN）的临床参数。与非糖尿病肾病相比，DN的肾脏结局较差。我们检测了这些支持DN的临床参数是否与非活检患者的肾脏预后较差相关。在这项研究中，纳入了1330名患有2型糖尿病和慢性肾病1-4期的患者，并根据糖尿病（DM）病程>8年、DR或DN诊断模型进行分组。在62-77%的患者中发现这些有利于DN的临床参数，并与较高水平的蛋白尿相关。在一项考克斯生存分析中，DR和支持DN的诊断模型与终末期肾病风险增加相关，校正后的风险比分别为1.69（95% CI：1.16-2.45，P = 0.006）和1.66（95% CI：1.05-2.61，P = 0.029）。DR与肾脏疾病快速进展的风险增加相关。DM >8年与肾脏预后无关。倾向评分匹配分析也显示了类似的结果。总之，DR和支持DN的诊断模型与较差的肾脏结局相关。
Diabetes duration, diabetic retinopathy (DR), and a diagnostic model have been proposed as clinical parameters favoring the presence of diabetic nephropathy (DN) in biopsied patients with diabetic kidney disease. DN, compared with non-diabetic renal disease, had poorer renal outcomes. We tested whether these clinical parameters favoring DN are associated with poorer renal outcomes in non-biopsied patients. In this study, 1330 patients with type 2 diabetes and chronic kidney disease stages 1–4 were included and divided according to diabetes mellitus (DM) duration >8 years, DR, or a diagnostic model for DN. These clinical parameters favoring DN were found in 62–77% of patients and associated with higher levels of proteinuria. In a Cox survival analysis, DR and the diagnostic model favoring DN were associated with an increased risk for end-stage renal disease with adjusted hazard ratios of 1.69 (95% CI: 1.16–2.45, P = 0.006) and 1.66 (95% CI: 1.05–2.61, P = 0.029), respectively. DR was associated with an increased risk for rapid renal disease progression. DM >8 years was not associated with renal outcome. Propensity score-matched analyses also showed similar results. In conclusion, DR and the diagnostic model favoring DN were associated with poorer renal outcomes.