Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study
Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study
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DOI：
10.1007/s10157-017-1451-4
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发表时间：
2018-04-01
影响因子：
2.3
通讯作者：
Ito, Sadayoshi
中科院分区：
文献类型：
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作者：
Iwai, Toshiki;Miyazaki, Mariko;Ito, Sadayoshi
糖尿病(DM)是终末期肾病(ESKD)的主要原因。然而，糖尿病合并非糖尿病肾病(DM和NDRD)患者和糖尿病肾病(DN)患者之间的肾脏结局的差异是有争议的。本研究的目的是在前瞻性观察研究中评估糖尿病肾病、糖尿病肾病、糖尿病肾病和非糖尿病慢性肾脏病(CKD)患者之间的差异。我们从11个肾病护理中心抽取2484名患者的数据，并将其分为上述三组。主要结果是ESKD需要肾脏替代治疗。在4.44年的中位随访期间，281名患者(11.3%)发展为ESKD。糖尿病和NDRD患者的肾脏结局与非DM患者相似(pae 0.05)。在CKD分期G3b时，糖尿病肾病患者发生ESKD的危险比(95%可信区间)为7.10(2.46~20.49)，糖尿病和NDRD患者为0.89(0.19~4.24)。估计肾小球滤过率(EGFR)在糖尿病患者中的年变化显著大于G3b期的其他组(-9.7%/年)。我们发现，糖尿病患者比糖尿病和NDRD或非糖尿病患者患ESKD的风险更高。尤其是在G3b期，糖尿病肾病患者的GFR迅速下降。无论DM和NDRD患者与糖尿病肾病患者的代谢特征相似，他们都可以实现与非DM CKD患者同样有益的肾脏结果。总之，我们应该谨慎地考虑糖尿病的危险分层，无论是CKD的病因还是合并疾病。
Diabetes mellitus (DM) is a major cause of end-stage kidney disease (ESKD). However, the difference in renal outcomes between DM patients with non-diabetic renal disease (DM and NDRD) and those with diabetic nephropathy (DN) is controversial. The aim of the present study was to evaluate the differences among patients with DN, DM, and NDRD, and non-DM chronic kidney disease (CKD) in a prospective observational study.We extracted the data of 2484 patients from 11 nephrology care centers and categorized into three groups as described above. The primary outcome was ESKD requiring renal replacement therapy.During the median follow-up of 4.44 years, 281 patients (11.3%) developed ESKD. Renal outcomes of DM and NDRD patients were similar to those of non-DM patients (p ae 0.05). At CKD stage G3b, the hazard ratios (95% confidence intervals) of ESKD were 7.10 (2.46-20.49) in DN patients and 0.89 (0.19-4.24) in DM and NDRD. The annual change in the estimated glomerular filtration rate (eGFR) in DN patients was significantly larger than that in other groups at stage G3b (-9.7%/year).We found that DN patients have a higher risk for ESKD than DM and NDRD or non-DM patients. In particular, GFR rapidly declined in DN at stage G3b. DM and NDRD patients can accomplish equally beneficial renal outcomes as non-DM CKD, regardless of their similar metabolic profiles as DN. In conclusion, we should prudentially consider the risk stratification of DM whether cause or comorbidity of CKD.