The Presence and Consequence of Nonalbuminuric Chronic Kidney Disease in Patients With Type 1 Diabetes
The Presence and Consequence of Nonalbuminuric Chronic Kidney Disease in Patients With Type 1 Diabetes
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DOI：
10.2337/dc15-0641
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发表时间：
2015-11-01
期刊：
影响因子：
16.2
通讯作者：
Forsblom, Carol M.
中科院分区：
文献类型：
--
作者：
Thorn, Lena M.;Gordin, Daniel;Forsblom, Carol M.
目的：本研究调查非蛋白尿慢性肾脏疾病在1型糖尿病中的患病率，以评估其是否会增加心血管和肾脏结局的风险以及全因死亡率。研究设计和方法：这是一项来自芬兰糖尿病肾病研究的3,809例1型糖尿病患者的观察性随访研究。所有患者均为白种人，并在基线时进行了彻底检查。他们的平均年龄为37.6 +/- 11.8岁，糖尿病病程为21.2 +/- 12.1年。从登记处检索心血管和肾脏结局及死亡率的随访数据。在13年的中位随访期间，378人发展为终末期肾病，415人发生心血管事件，406人死亡。结果基线时，78例（2.0%）患有非蛋白尿性慢性肾病。这与年龄、女性、视网膜激光治疗史、心血管事件和使用的降压药数量有关，但与血压水平或特定的降压药无关。非白蛋白尿慢性肾脏疾病不会增加白蛋白尿（危险比[HR] 2.0 [95% CI 0.9-4.4]）或终末期肾脏疾病（HR 6.4[0.8-53.0]）的风险，但会增加心血管事件（HR 2.0[1.4-3.5]）和全因死亡率（HR 2.4[1.4-3.9]）的风险。在蛋白尿患者中观察到心血管和肾脏终点的最高风险。结论：非白蛋白尿慢性肾病在1型糖尿病患者中并不常见，但如果存在，则与心血管发病率和全因死亡率的增加相关，但与肾脏预后无关。
OBJECTIVEThis study investigated the prevalence of nonalbuminuric chronic kidney disease in type 1 diabetes to assess whether it increases the risk of cardiovascular and renal outcomes as well as all-cause mortality.RESEARCH DESIGN AND METHODSThis was an observational follow-up of 3,809 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. All patients were Caucasians and thoroughly examined at baseline. Their mean age was 37.6 +/- 11.8 years and duration of diabetes 21.2 +/- 12.1 years. Follow-up data on cardiovascular and renal outcomes and mortality were retrieved from registers. During 13 years of median follow-up, 378 developed end-stage renal disease, 415 suffered an incident cardiovascular event, and 406 died.RESULTSAt baseline, 78 (2.0%) had nonalbuminuric chronic kidney disease. This was associated with older age, female sex, history of retinal laser treatment, cardiovascular events, and the number of antihypertensive drugs in use, but not with blood pressure levels or specific antihypertensive agents. Nonalbuminuric chronic kidney disease did not increase the risk of albuminuria (hazard ratio [HR] 2.0 [95% CI 0.9-4.4]) or end-stage renal disease (HR 6.4 [0.8-53.0]) but did increase the risk of cardiovascular events (HR 2.0 [1.4-3.5]) and all-cause mortality (HR 2.4 [1.4-3.9]). The highest risk of cardiovascular and renal end points was observed in the patients with albuminuria.CONCLUSIONSNonalbuminuric chronic kidney disease is not a frequent finding in patients with type 1 diabetes, but when present, it is associated with an increased risk of cardiovascular morbidity and all-cause mortality but not with renal outcomes.