Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort.
Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort.
复制标题
DOI：
10.1001/archinternmed.2011.16
复制
发表时间：
2011-03-14
影响因子：
--
通讯作者：
Brunzell, John D.
中科院分区：
文献类型：
--
作者：
de Boer, Ian H.;Rue, Tessa C.;Cleary, Patricia A.;Lachin, John M.;Molitch, Mark E.;Steffes, Michael W.;Sun, Wanjie;Zinman, Bernard;Brunzell, John D.
微量白蛋白尿是1型糖尿病患者临床护理中的常见诊断。发生微量白蛋白尿后的长期预后是可变的。在DCCT/EDIC研究中，我们量化了发生微量白蛋白尿后长期肾脏结局的发生率和风险因素。DCCT将1441名1型糖尿病患者随机分为强化或常规糖尿病治疗组，随后在EDIC观察性研究中对参与者进行随访。在DCCT/EDIC期间，325例受试者发生了偶发性持续性微量白蛋白尿（连续两次研究访视时白蛋白排泄率[AER] ≥ 30 mg/24 hr）。我们评估了他们随后的肾脏结局，包括进展为大量白蛋白尿（AER ≥ 300 mg/24 hr x2）、肾小球滤过率受损（估计GFR < 60 mL/min/1.73 m2 x2）和终末期肾病（ESRD），以及恢复为正常白蛋白尿（AER < 30 mg/24 hr x2）。诊断为持续性微量白蛋白尿后的中位随访时间为13年（最长23年）。10-进展为大量白蛋白尿、GFR受损和ESRD以及恢复为正常白蛋白尿的年累积发生率分别为28%、15%、3%和40%。强化糖尿病治疗、血红蛋白A1 c降低、无视网膜病变、女性、血压降低、LDL胆固醇和甘油三酯浓度降低的患者，白蛋白尿结局更有利。较低的血红蛋白A1 c、无视网膜病变和较低的血压也与GFR受损风险降低相关。在持续性微量白蛋白尿发生后，肾脏疾病的进展和消退各有发生。强化血糖控制、降低血压和更有利的血脂与改善结局相关。
Microalbuminuria is a common diagnosis in the clinical care of patients with type 1 diabetes. Long-term outcomes after the development of microalbuminuria are variable. We quantified the incidence of and risk factors for long-term renal outcomes after the development of microalbuminuria in the DCCT/EDIC Study. The DCCT randomly assigned 1441 persons with type 1 diabetes to intensive or conventional diabetes therapy, and participants were subsequently followed during the observational EDIC Study. During DCCT/EDIC, 325 participants developed incident persistent microalbuminuria (albumin excretion rate [AER] ≥ 30 mg/24hr on two consecutive study visits). We assessed their subsequent renal outcomes, including progression to macroalbuminuria (AER ≥ 300 mg/24hr x2), impaired glomerular filtration rate (estimated GFR < 60 mL/min/1.73m2 x2), and end stage renal disease (ESRD), and regression to normoalbuminuria (AER < 30 mg/24hr x2). Median follow-up after persistent microalbuminuria diagnosis was 13 years (maximum 23 years). 10-year cumulative incidences of progression to macroalbuminuria, impaired GFR, and ESRD and regression to normoalbuminuria were 28%, 15%, 3%, and 40%, respectively. Albuminuria outcomes were more favorable with intensive diabetes therapy, lower hemoglobin A1c, lack of retinopathy, female gender, lower blood pressure, and lower concentrations of LDL cholesterol and triglyceride. Lower hemoglobin A1c, lack of retinopathy, and lower blood pressure were also associated with decreased risk of impaired GFR. After the development of persistent microalbuminuria, progression and regression of kidney disease each occur commonly. Intensive glycemic control, lower blood pressure, and a more favorable lipid profile are associated with improved outcomes.
登录
查看更多内容
影响因子：
6.1
作者：
Dahlquist, G;Stattin, EL;Rudberg, S
通讯作者：
Rudberg, S
影响因子：
16.2
作者：
Bojestig, M;Arnqvist, HJ;Ludvigsson, J
通讯作者：
Ludvigsson, J
影响因子：
19.6
作者：
Orchard, TJ;Chang, YF;Ellis, DE
通讯作者：
Ellis, DE
糖尿病的医疗标准 - 2009年。
影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
影响因子：
158.5
作者：
Lewis, EJ;Hunsicker, LG;Raz, I
通讯作者：
Raz, I