Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria
Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria
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DOI：
10.1681/asn.2010020194
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发表时间：
2011-03-01
影响因子：
13.6
通讯作者：
Groop, Per-Henrik
中科院分区：
文献类型：
--
作者：
Forsblom, Carol;Harjutsalo, Velma;Groop, Per-Henrik
同时患有1型糖尿病和慢性肾脏病的患者不良结局的风险增加。死亡和ESRD的相互竞争的风险可能会混淆对每种结果的风险估计。在这里，我们试图确定1型糖尿病和大量白蛋白尿患者ESRD累积发病率和ESRD前期死亡率的主要预测因素，同时将替代结果的竞争风险纳入Fine-Gray竞争风险分析。我们对592例大量蛋白尿患者进行了平均9.9年的跟踪调查。在此期间，56名患者(9.5%)死亡，210名患者(35.5%)发展为终末期肾病。考虑到基线肾功能和相互竞争的死亡风险，ESRD事件的预测因素包括糖化血红蛋白(1c)升高、低密度脂蛋白(LDL)升高、男性、体重调整后的胰岛素剂量和较短的糖尿病病程。相比之下，考虑到基线肾功能和终末期肾病的竞争风险，预测终末期肾病前期死亡的因素只包括年龄、既有大血管疾病的存在和胆固醇水平的升高。这种相互竞争的风险方法有可能突出预防1型糖尿病患者过早死亡的适当目标和战略。
Patients with both type 1 diabetes and CKD have an increased risk of adverse outcomes. The competing risks of death and ESRD may confound the estimates of risk for each outcome. Here, we sought to determine the major predictors of the cumulative incidence of ESRD and pre-ESRD mortality in patients with type 1 diabetes and macroalbuminuria while incorporating the competing risk for the alternate outcome into a Fine-Gray competing-risks analysis. We followed 592 patients with macroalbuminuria for a median of 9.9 years. During this time, 56 (9.5%) patients died and 210 (35.5%) patients developed ESRD. Predictors of incident ESRD, taking baseline renal function and the competing risk for death into account, included an elevated HbA(1c), elevated LDL cholesterol, male sex, weight-adjusted insulin dose, and a shorter duration of diabetes. By contrast, predictors of pre-ESRD death, taking baseline renal function and the competing risk for ESRD into account, included only age, the presence of established macrovascular disease, and elevated cholesterol levels. This competing-risks approach has potential to highlight the appropriate targets and strategies for preventing premature mortality in patients with type 1 diabetes.