Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease
Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease
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DOI：
10.1016/j.atherosclerosis.2015.06.048
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发表时间：
2015-09-01
期刊：
影响因子：
5.3
通讯作者：
Valdivielso, Jose M.
中科院分区：
文献类型：
--
作者：
Barrios, Clara;Pascual, Julio;Valdivielso, Jose M.
背景：动脉粥样硬化性疾病（AD）是肾脏病患者死亡的危险因素。传统的CV风险因素并不能预测该人群中AD的存在。本研究的目的是分析原发性肾脏疾病的病因是否会影响无症状AD的风险。研究设计：在既往无心血管事件的慢性肾脏疾病患者中进行观察性横断面研究。设置和参与者：2436例既往无任何CV事件的CKD受试者纳入前瞻性西班牙多中心NEFRONA研究。患者根据原发性肾脏疾病分类：糖尿病肾病（n = 347）、血管性肾病（n = 476）、全身性/肾小球疾病（n = 447）、肾小管间质性和药物毒性肾病（n = 320）、多囊肾病（n = 238）、非丝状肾病（n = 406）和其他原因（n = 202）。对颈动脉进行B型和多普勒超声分析，以测量内膜-中膜厚度（IMT）和斑块的存在。结果：根据超声检查结果和踝臂指数将AD分为两大组：无AD或早期AD和重度AD。在多变量回归分析中，（OR 1.09/年[1.088-1.108]），吸烟习惯（OR 2.10 [1.61-2.74]），男性（OR 1.33 [1.09-1.64]）、CKD 5级（OR 2.19 [1.74-2.74]）和糖尿病肾病（OR 2.59 [1.93-3.48]）是重度AD的独立危险因素。无症状AD的患病率最高的是糖尿病肾病伴5级CKD（82.2%），最低的是2-3期CKD全身/肾小球疾病（36.6%）。局限性：结论：在背景临床病史中无任何CV事件的CKD患者中，糖尿病肾病作为原发性肾脏疾病是与重度无症状AD相关的最重要因素。此外，这种差异与动脉粥样硬化和CV事件的其他传统风险因素无关。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Background: Atheromatous disease (AD) is a risk factor for death in renal patients. Traditional CV risk factors do not predict the presence of AD in this population. The aim of this study is to analyze whether the etiology of the primary renal disease influences in the risk of having silent AD.Study design: Observational cross-sectional study in chronic kidney disease patients without previous cardiovascular events.Settings and Participants: 2436 CKD subjects without any previous CV event included in the prospective Spanish multicenter NEFRONA study. Patients were classified according to primary renal disease: diabetic nephropathy (n = 347), vascular nephropathy (n = 476), systemic/glomerular disease (n = 447), tubulointerstitial and drug toxicity nephropathy (n = 320), polycystic kidney disease (n = 238), non-filiated nephropathy (n = 406) and other causes (n = 202).Predictors: B-mode and Doppler ultrasonography analysis of the carotid arteries were performed to measure intima media thickness (IMT) and the presence of plaques. Clinical and laboratory parameters related to CV risk were also determined.Outcomes: AD was scored according with the ultrasonography findings and the ankle-brachial index into two large groups: absence or incipient AD and severe AD.Results: In multivariate regression analysis, older age (OR 1.09/year [1.088-1.108]), smoking habit (OR 2.10 [1.61-2.74]), male gender (OR 1.33 [1.09-1.64]), grade-5D of CKD (OR 2.19 [1.74-2.74]), and diabetic nephropathy (OR 2.59 [1.93-3.48]) are independent risk factors for severe AD. The prevalence of silent AD was highest for diabetic nephropathy with grade-5D of CKD (82.2%) and lowest with stages 2-3 CKD systemic/glomerular disease (36.6%). Limitations: Observational study with the potential for confounding.Conclusion: In CKD patients without any CV event in the background clinical history, diabetic nephropathy as primary renal disease is the most significant factor associated to severe silent AD. Furthermore, this difference was independent of other conventional risk factors for atherosclerosis and CV events. (C) 2015 Elsevier Ireland Ltd. All rights reserved.