Progression of chronic kidney disease in a multi-ethnic community cohort of patients with diabetes mellitus
Progression of chronic kidney disease in a multi-ethnic community cohort of patients with diabetes mellitus
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DOI：
10.1111/dme.12197
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发表时间：
2013-08-01
影响因子：
3.5
通讯作者：
Yaqoob, M. M.
中科院分区：
文献类型：
--
作者：
Dreyer, G.;Hull, S.;Yaqoob, M. M.
目的种族是糖尿病患者中严重慢性肾脏病患病率的一个危险因素。我们研究了种族对社区糖尿病患者慢性肾脏疾病进展的影响。方法对3855例白色、黑人或南亚种族的糖尿病患者进行了为期5年的回顾性、基于社区的队列研究，估计肾小球滤过率< 60 ml min（-1）1.73 m（-2）。从东伦敦的135个全科诊所中，纳入了至少有3年临床数据的所有病例。使用重复测量分析，计算估计肾小球滤过率的年下降。在三个主要种族组之间的下降率进行了比较，在基线时有和没有蛋白尿，made.Results的估计肾小球滤过率的年度调整下降为0.85 ml min（-1）1.73 m（-2）。与白色组（-0.70 ml min（-1）1.73 m（-2））相比，南亚组（-1.01 ml min（-1）1.73 m（-2））的慢性肾脏疾病进展率显著更高（P = 0.001）。对于那些基线时有蛋白尿的患者，年下降幅度更大，为2.05 ml min（-1）1.73 m（-2），南亚和黑人组的下降速度明显快于白色组。肾功能的年下降比以前认为的要少，接近年龄相关的年下降1 ml min（-1）1.73 m（-2）。蛋白尿患者以及南亚和黑人种族的患者需要额外监测，因为他们的慢性肾脏疾病快速进展的风险更大。
Aims Ethnicity is a risk factor for the prevalence of severe chronic kidney disease among patients with diabetes. We studied the effect of ethnicity on progression of chronic kidney disease in people with diabetes managed in community settings.Methods A 5-year retrospective, community-based cohort study of 3855 people with diabetes mellitus of white, black or South Asian ethnicity with an estimated glomerular filtration rate of < 60 ml min(-1) 1.73 m(-2) was undertaken. From 135 general practices in east London, all cases with at least 3 years clinical data were included. Using repeated-measures analysis, the annual decline in estimated glomerular filtration rate was calculated. Comparisons between the rate of decline in the three main ethnic groups, with and without proteinuria at baseline, were made.Results The annual adjusted decline in estimated glomerular filtration rate for this cohort was 0.85 ml min(-1) 1.73 m(-2). The rate of chronic kidney disease progression was significantly greater in South Asian groups (-1.01 ml min(-1) 1.73 m(-2)) compared with white groups (-0.70 ml min(-1) 1.73 m(-2)) (P = 0.001). For those with proteinuria at baseline, the annual decline was greater at 2.05 ml min(-1) 1.73 m(-2), with both South Asian and black groups having a significantly faster rate of decline than white groups.Conclusions For patients with diabetes and chronic kidney disease managed in primary care, the annual decline of renal function is less than previously thought and approximates the age-related annual decline of 1 ml min(-1) 1.73 m(-2). Patients with proteinuria and those of South Asian and Black ethnicity need additional monitoring as they are at greater risk of rapid chronic kidney disease progression.