High cardiovascular risk in patients with Type 2 diabetic nephropathy: the predictive role of albuminuria and glomerular filtration rate. The NID-2 Prospective Cohort Study
High cardiovascular risk in patients with Type 2 diabetic nephropathy: the predictive role of albuminuria and glomerular filtration rate. The NID-2 Prospective Cohort Study
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DOI：
10.1093/ndt/gfr644
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发表时间：
2012-06-01
影响因子：
6.1
通讯作者：
Minutolo, Roberto
中科院分区：
文献类型：
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作者：
Sasso, Ferdinando C.;Chiodini, Paolo;Minutolo, Roberto
背景在2型糖尿病患者中，糖尿病肾病（DN）的临床诊断通常基于异常白蛋白尿和严重视网膜病变的伴随存在。在这一高危人群中，心血管（CV）结局从未得到评估。选择来自17个国家中心的742例2型糖尿病DN患者，根据持续性白蛋白尿≥ 30 mg/d和严重糖尿病视网膜病变的存在进行前瞻性随访。至CV事件（CV死亡、非致死性心肌梗死、非致死性卒中、血运重建、大截肢）的时间是主要复合终点，并通过多变量考克斯比例风险模型进行分析。特别研究了蛋白尿和肾小球滤过率（GFR）之间的相互作用。中位随访时间为4.6年。在202例患者中共观察到242起事件（其中26%为致死性）。随着GFR从最高（>= 90 mL/min/1.73m（2））降至最低（
Background. In Type 2 diabetic patients, clinical diagnosis of diabetic nephropathy (DN) is generally based on the concomitant presence of abnormal albuminuria and severe retinopathy. In this high-risk population, cardiovascular (CV) outcome has never been evaluated.Methods. A cohort of 742 Type 2 diabetic patients with DN from 17 national centres was selected by the presence of persistent albuminuria >= 30 mg/day and severe diabetic retinopathy and was followed prospectively. Time to CV event (CV death, non-fatal myocardial infarction, non-fatal stroke, revascularization, major amputation) was the primary composite end point and it was analysed by multivariable Cox's proportional hazards model. The interaction between albuminuria and glomerular filtration rate (GFR) was specifically investigated.Results. Median follow-up was 4.6 years. Overall 242 events (26% of which fatal) were observed in 202 patients. The proportion of CV events increased from 19 to 40% as GFR declined from the highest (>= 90 mL/min/1.73m(2)) to the lowest (