Association of the estimated glomerular filtration rate (eGFR) and/or proteinuria to predict the risk of initiation of dialysis in people with and without diabetes
Association of the estimated glomerular filtration rate (eGFR) and/or proteinuria to predict the risk of initiation of dialysis in people with and without diabetes
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DOI：
10.1007/s13340-022-00603-z
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发表时间：
2022-09
影响因子：
2.2
通讯作者：
T. Osawa;K. Fujihara;M. Yamada;Yuta Yaguchi;Takaaki Sato;Masaru Kitazawa;Y. Matsubayashi;Takaho Yamada;S. Kodama;H. Sone
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文献类型：
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作者：
T. Osawa;K. Fujihara;M. Yamada;Yuta Yaguchi;Takaaki Sato;Masaru Kitazawa;Y. Matsubayashi;Takaho Yamada;S. Kodama;H. Sone
AimsTo确定联合尿蛋白（UP）和降低估计肾小球滤过率（eGFR）和风险开始透析与或不与糖尿病（DM）之间的关联MethodsA全国范围内的数据库与索赔数据335,778人，年龄在19-72岁的糖尿病和非糖尿病在日本被用来阐明的严重程度的影响UP和eGFR开始透析。根据使用ICD-10代码和医疗程序的声明确定是否开始透析。使用多变量考克斯模型，我们调查了严重的UP和eGFR预测透析开始与DM和不DM。结果eGFR < 60和UP（+）是独立的预测因素开始透析与DM和不DM，和他们的价值表现出协同风险的透析。eGFR < 60的患者开始透析的风险几乎是UP（+）的2倍，与DM无关。UP（+）和eGFR ≥ 60伴糖尿病患者开始透析的风险增加，尽管在无糖尿病的情况下未观察到这种相关性。UP（−）和eGFR < 60的患者开始透析的风险很高，与DM无关。与DM（−）UP（−）eGFR ≥ 60相比，DM（+）UP（+）eGFR ≥ 60、DM（+）UP（−）eGFR < 60和DM（+）UP（+）eGFR < 60开始透析的HR显著增加17.7（10.6-29.7）、25.5（13.8-47.1）和358.1（239.1-536.5）倍。无论糖尿病患者的eGFR如何，UP（+）都会增加开始透析的风险。患者教育和医生的治疗策略可能有助于避免肾衰竭的进展。
AimsTo determine the associations between combined urinary protein (UP) and a reduced estimated glomerular filtration rate (eGFR) and the risk of starting dialysis with or without diabetes mellitus (DM).MethodsA nationwide database with claims data on 335,778 people with and without DM aged 19–72 years in Japan was used to elucidate the impact of the severities of UP and eGFR on starting dialysis. Initiation of dialysis was determined from claims using ICD-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severities of UP and eGFR to predict the initiation of dialysis with and without DM.ResultsBoth eGFR < 60 and UP(+) were independent predictors for starting dialysis with and without DM, and their values exhibited a synergistic risk of dialysis. eGFR < 60 presented a nearly twofold risk for starting dialysis compared to UP(+) regardless of DM. Risk of starting dialysis was increased with UP(+) and eGFR ≥ 60 accompanied by DM although this association was not observed without DM. Those who had UP(−) and eGFR < 60 had a high risk of starting dialysis regardless of DM. Compared with DM(−)UP(−)eGFR ≥ 60, HRs for starting dialysis for DM(+)UP(+)eGFR ≥ 60, DM(+)UP(−)eGFR < 60 and DM(+)UP(+)eGFR < 60 significantly increased 17.7 (10.6–29.7), 25.5 (13.8–47.1) and 358.1 (239.1–536.5) times, respectively.ConclusionseGFR < 60 and UP(+) together presented an extremely high risk of dialysis especially with DM. UP( +) increased the risk of starting dialysis regardless of the eGFR with DM. Both patient education and a treatment strategy by physicians might be helpful to avoid the progression of renal failure.