Estimated glomerular filtration rate, albuminuria and mortality in type 2 diabetes: the Casale Monferrato study
Estimated glomerular filtration rate, albuminuria and mortality in type 2 diabetes: the Casale Monferrato study
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DOI：
10.1007/s00125-007-0616-1
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发表时间：
2007-05-01
期刊：
影响因子：
8.2
通讯作者：
Cavallo-Perin, P.
中科院分区：
文献类型：
--
作者：
Bruno, G.;Merletti, F.;Cavallo-Perin, P.
目的/假设：估计肾小球滤过率（eGFR）预测非糖尿病人群的死亡率，但其在2型糖尿病患者中的作用尚不清楚。我们评估了2型糖尿病患者eGFR降低在多大程度上预测11年全因死亡率和心血管死亡率，独立于AER和其他心血管危险因素。材料和方法：研究人群为Casale Monferrato研究的基于人群的队列（n = 1538，中位年龄68.9岁）。GFR是通过肾脏疾病研究方程中饮食的简化修正来估计的。结果：基线时，慢性肾脏疾病(eGFR < 60 ml min（-1) 1.73 m(-2)）的患病率为34.3% （95% CI 33.0-36.8）。在10708人年的观察中，有670人死亡。校正心血管危险因素和AER后，全因死亡率的风险比为1.23 (95% CI 1.03-1.47)，心血管死亡率的风险比为1.18 （95% CI 0.92-1.52）。当对5个eGFR水平进行分析时，我们发现eGFR在15-29 ml min(-1) 1.73 m（-2）之间的风险最大，而eGFR在30 - 59 ml min(-1) 1.73 m（-2）之间的风险没有明显增加。在一项按AER分类分层的分析中，只有在大量蛋白尿患者中，随着eGFR的降低，风险有显著增加的趋势。结论/解释：我们的研究表明，在2型糖尿病中，大量蛋白尿是死亡率的主要预测因子，独立于eGFR和心血管危险因素，而在正常蛋白尿人群中，eGFR不能提供进一步的信息。
Aims/hypothesis: Estimated glomerular filtration rate (eGFR) predicts mortality in non-diabetic populations, but its role in people with type 2 diabetes is unknown. We assessed to what extent a reduction in eGFR in people with type 2 diabetes predicts 11-year all-cause and cardiovascular mortality, independently of AER and other cardiovascular risk factors.Materials and methods: The study population was the population-based cohort (n = 1,538; median age 68.9 years) of the Casale Monferrato Study. GFR was estimated by the abbreviated Modification of Diet in Renal Disease Study equation.Results: At baseline, the prevalence of chronic kidney disease (eGFR < 60 ml min(-1) 1.73 m(-2)) was 34.3% (95% CI 33.0-36.8). There were 670 deaths in 10,708 person-years of observation. Hazard ratios of 1.23 (95% CI 1.03-1.47) for all-cause mortality and 1.18 (95% CI 0.92-1.52) for cardiovascular mortality were observed after adjusting for cardiovascular risk factors and AER. When five levels of eGFR were analysed we found that most risk was conferred by eGFR 15-29 ml min(-1) 1.73 m(-2), whereas no increased risk was evident in people with eGFR values between 30 and 59 ml min(-1) 1.73 m(-2). In an analysis stratified by AER categories, a significant increasing trend in risk with decreasing eGFR was evident only in people with macroalbuminuria.Conclusions/interpretation: Our study suggests that in type 2 diabetes macroalbuminuria is the main predictor of mortality, independently of both eGFR and cardiovascular risk factors, whereas eGFR provides no further information in normoalbuminuric people.