Risk of End-stage Renal Disease in Diabetes Mellitus: A Prospective Cohort Study of Men Screened for MRFIT
Risk of End-stage Renal Disease in Diabetes Mellitus: A Prospective Cohort Study of Men Screened for MRFIT
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DOI：
10.1001/jama.1997.03550230045035
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发表时间：
1997-12
期刊：
影响因子：
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通讯作者：
F. Brancati;P. Whelton;B. Randall;J. Neaton;J. Stamler;M. Klag
中科院分区：
文献类型：
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作者：
F. Brancati;P. Whelton;B. Randall;J. Neaton;J. Stamler;M. Klag
上下文。-糖尿病是终末期肾病(ESRD)的常见原因。然而，风险程度尚不确定。目标。-确定美国与糖尿病相关的终末期肾病的相对风险(RR)。设计。-非同期前瞻性队列研究。与会者。-1973年至1975年，来自美国18个城市的332 544名年龄在35岁至57岁之间的男性接受了多风险因素干预试验(MRFIT)的筛查。主要曝光。-糖尿病的定义是在基线水平自我报告的糖尿病药物使用情况。主要结果。-通过国家ESRD登记和肾脏疾病死亡监测对1990年的ESRD事件进行评估。结果。-在平均16年的随访中，在5147名糖尿病男性中有136例终末期肾病，在327 397名非糖尿病男性中有678例。糖尿病男性全因终末期肾病的年龄调整发病率为199.8/10万人年，而非糖尿病男性为13.7/10万人年(相对危险度12.7；95%可信区间10.5-15.4)。糖尿病男性患ESRD的风险也更高，归因于糖尿病以外的原因(RR=4.3；95%CI，3.2-5.9)。在对年龄、种族、收入、血压、血清胆固醇水平和心肌梗死病史进行同步调整后，糖尿病男性仍有更高的风险罹患各种原因的终末期肾病(RR，9.0；95%CI，7.4-11.0)，归因于糖尿病的终末期肾病(RR，92.3；95%CI，64.6-131.9)，以及非糖尿病原因的终末期肾病(RR，3.0；95%CI，2.2-4.1)。结论。-糖尿病是ESRD的一个强大的独立危险因素，即使对于被归因于糖尿病以外的其他原因的ESRD也是如此。在预防和控制糖尿病方面的改进应能大幅降低终末期肾病的发病率。
Context. —Diabetes is a frequent cause of end-stage renal disease (ESRD). However, the degree of risk is uncertain. Objective. —To determine the relative risk (RR) of ESRD related to diabetes in the United States. Design. —Nonconcurrent prospective cohort study. Participants. —A total of 332 544 men aged 35 to 57 years from 18 US cities screened in 1973 to 1975 for participation in the Multiple Risk Factor Intervention Trial (MRFIT). Main Exposure. —Diabetes mellitus defined by self-reported use of medication for diabetes at baseline. Main Outcome. —Incident ESRD through 1990 assessed from a national ESRD registry and by surveillance for death from renal disease. Results. —Over an average follow-up of 16 years, there were 136 cases of ESRD in 5147 diabetic men and 678 cases in 327 397 nondiabetic men. Age-adjusted incidence of all-cause ESRD in the diabetic men was 199.8 per 100 000 person-years compared with 13.7 per 100 000 person years in their nondiabetic counterparts (RR, 12.7; 95% confidence interval [Cl], 10.5-15.4). Diabetic men were also at higher risk for ESRD ascribed to causes other than diabetes (RR=4.3; 95% Cl, 3.2-5.9). With simultaneous adjustment for age, ethnicity, income, blood pressure, serum cholesterol level, and history of myocardial infarction, diabetic men remained at higher risk for all-cause ESRD (RR, 9.0; 95% Cl, 7.4-11.0), ESRD ascribed to diabetes (RR, 92.3; 95% Cl, 64.6-131.9), and ESRD ascribed to nondiabetic causes (RR, 3.0; 95% Cl, 2.2-4.1). Conclusions. —Diabetes mellitus is a strong independent risk factor for ESRD, even for ESRD ascribed to causes other than diabetes. Improvements in the prevention and control of diabetes should produce substantial reductions in ESRD incidence.