Magnitude of end-stage renal disease in IDDM: A 35 year follow-up study
Magnitude of end-stage renal disease in IDDM: A 35 year follow-up study
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DOI：
10.1038/ki.1996.527
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发表时间：
1996-12-01
影响因子：
19.6
通讯作者：
Warram, JH
中科院分区：
文献类型：
--
作者：
Krolewski, M;Eggers, PW;Warram, JH
过去二十年，IDDM 患者的治疗取得了重大进展。为了评估接受这些改善的人群中 ESRD 的风险，我们确定了 142 名白人患者的 ESRD 累积发病率，这些患者于 1959 年来到 Joslin 糖尿病中心，最近被诊断为 IDDM，年龄不到 21 岁。第一例 ESRD 发生在 IDDM 13 年后，至 35 年共发生 25 例（累积发生率 21.3%）。 16 名开始透析的患者诊断 ESRD 后的中位生存期仅为 3.5 年。 ESRD 发展的一个强有力的预测因素是 IDDM 前二十年的血糖控制水平。在血糖控制最差的三分位数中，有 36.3% 的患者出现 ESRD，但在中间和最好的三分位数中，这一比例仅为 14.4% 和 9.2%。与两项基于人群的研究相比，Joslin 队列中 ESRD 的发病推迟了约五年。这一优势更有可能归因于糖尿病诊断后出现的差异，而不是将不太严重的 IDDM 病例转诊至乔斯林糖尿病中心。从已发表的研究之间的比较中无法看出糖尿病护理方面的差异导致终末期肾病的推迟，但可能的原因包括乔斯林长期倡导良好的血糖控制和及时实施新的临床干预措施，例如抗高血压治疗。
Significant improvements were made during the last two decades in the treatment of IDDM patients. To assess the risk of ESRD in a population that was exposed to these improvements, we determined the cumulative incidence of ESRD in a cohort of 142 white patients who were aged less than 21 years when they came to the Joslin Diabetes Center in 1959 with recently diagnosed IDDM. The first case of ESRD occurred after 13 years of IDDM, and a total of 25 cases have developed by 35 years' duration (cumulative incidence 21.3%). Median survival after the diagnosis Of ESRD for the 16 patients who began dialysis was only 3.5 years. A strong predictor of the development of ESRD was the level of glycemic control during the first two decades of IDDM. ESRD developed in 36.3% of patients in the worst tertile for glycemic control but only in 14.4% and 9.2% of those in the middle and best tertiles. In comparison with two population based studies, the onset of ESRD in the Joslin Cohort was postponed by about five years. This advantage is more plausibly attributable to differences arising after the diagnosis of diabetes than to referral of less severe cases of IDDM to the Joslin Diabetes Center. What differences in diabetes care accounted for the postponement of ESRD cannot be discerned from comparisons among published studies, but likely candidates include Joslin's long-term advocacy of good glycemic control and the prompt implementation of new clinical interventions, such as antihypertensive treatment.