Incidence of end-stage renal disease and risk factors for progression of renal dysfunction in Japanese patients with type 2 diabetes: the Fukuoka Diabetes Registry
Incidence of end-stage renal disease and risk factors for progression of renal dysfunction in Japanese patients with type 2 diabetes: the Fukuoka Diabetes Registry
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DOI：
10.1007/s10157-021-02136-2
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发表时间：
2021-09-28
影响因子：
2.3
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Iwase, Masanori;Ide, Hitoshi;Kitazono, Takanari
背景在日本，糖尿病肾病的流行病学数据积累不足。我们前瞻性研究了日本2型糖尿病患者终末期肾病（ESRD）的发病率和肾功能不全进展的危险因素。方法对4904例2型糖尿病患者（平均年龄65岁，平均肾小球滤过率（eGFR）75 mL/min/1.73 m2，eGFR < 60 mL/min/1.73 m2的比例为21%）进行为期5年的ESRD透析研究。评估肾功能不全进展的风险因素（eGFR较基线下降>= 30%和eGFR年下降率）。结果ESRD的发病率和全因死亡率分别为4.1/1000人年和12.3/1000人年，并随着慢性肾脏病分期的增加而增加（eGFR < 30 mL/min/1.73 m2，ESRD的发病率为176.6/1000人年，全因死亡率为57.4/1000人年）。5年时eGFR较基线下降≥ 30%的发生率为16.4%，平均年下降率为-1.84 mL/min/1.73 m2/年。肾功能不全的进展与年龄较大、血糖控制不良、血压、蛋白尿、eGFR、既往心血管疾病、生活方式因素（体重指数、膳食纤维摄入减少、钠摄入增加、无规律运动）和抑郁症状显著相关。结论：这项前瞻性研究强调了多因素干预危险因素的重要性，以抑制日本2型糖尿病患者ESRD的高发病率。
Background Epidemiological data regarding diabetic kidney disease are accumulated insufficiently in Japan. We prospectively investigated the incidence of end-stage renal disease (ESRD) and risk factors for progression of renal dysfunction in Japanese patients with type 2 diabetes. Methods 4904 participants with type 2 diabetes (mean age 65 years, mean estimated glomerular filtration rate (eGFR) 75 mL/min/1.73 m(2), proportion of eGFR < 60 mL/min/1.73 m(2) 21%) were investigated for the progression to ESRD requiring dialysis in multicenter outpatients registry for 5 years. Risk factors for progression of renal dysfunction (>= 30% decline in eGFR from the baseline and annual eGFR decline rates) were evaluated. Results The incidence rates of ESRD and all-cause mortality were 4.1/1000 person-years and 12.3/1000 person-years, respectively, and increased according to stages of chronic kidney disease (eGFR < 30 mL/min/1.73 m(2), incidence of ESRD 176.6/1000 person-years, all-cause mortality 57.4/1000 person-years). Incidence of >= 30% decline in eGFR from the baseline was 16.4% at 5 years, and the mean annual decline rate was -1.84 mL/min/1.73 m(2)/year. The progression of renal dysfunction was significantly associated with older age, poor glycemic control, blood pressure, albuminuria, eGFR, previous cardiovascular disease, lifestyle factors (body mass index, reduced intake of dietary fiber, increased intake of sodium, no regular exercise), and depressive symptoms. Conclusions This prospective study has emphasized the importance of multifactorial interventions on risk factors to suppress the high incidence of ESRD in Japanese patients with type 2 diabetes.