Similar renal decline in diabetic and non-diabetic patients with comparable levels of albuminuria
Similar renal decline in diabetic and non-diabetic patients with comparable levels of albuminuria
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DOI：
10.1093/ndt/gfp475
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发表时间：
2010-03-01
影响因子：
6.1
通讯作者：
Torres, Armando
中科院分区：
文献类型：
--
作者：
Lorenzo, Victor;Saracho, Ramon;Torres, Armando
方法。在这项为期 7.5 年的观察性研究中，纳入了 333 名患者（年龄 67 +/- 15 岁，46% 患有糖尿病）。平均随访时间为 30 +/- 18 个月（范围 4-79）。应用时间相关的 Cox 模型评估研究变量的影响，并使用线性回归模型评估基于斜率的结果。结果。单变量分析以及调整年龄、性别和收缩压后，糖尿病状况与不良结果相关。然而，当控制白蛋白尿（一种时间依赖性协变量）时，糖尿病并未显示出与结果有任何关联。此外，在控制白蛋白尿的情况下，糖尿病和非糖尿病患者的肾功能衰退的平均斜率相似。在单变量和多变量模型中，尿白蛋白-肌酐比值是不良结果的有力预测因子。在糖尿病组中，时变糖化血红蛋白不影响 Cox 模型中的肾脏结果，时变蛋白尿仍然是结果的强有力预测因子。结论。糖尿病患者的肾脏结局较差，但在蛋白尿水平相当的情况下，糖尿病患者和非糖尿病患者的肾功能下降相似。蛋白尿是肾功能衰退的危险因素，也是中度至晚期 CKD 患者（无论是糖尿病患者还是非糖尿病患者）延缓病情进展的主要目标。
Methods. In this observational study, 333 patients (age 67 +/- 15 years, 46% diabetics) were included during a 7.5-year period. The mean follow-up was 30 +/- 18 months (range 4-79). The influence of study variables was evaluated applying a time-dependent Cox model and slope-based outcome using a linear regression model.Results. The diabetes condition was associated with adverse outcome in univariate analysis, and after adjusting for age, sex and systolic blood pressure. However, when controlling for albuminuria (a time-dependent covariate), diabetes did not show any association with outcome. In addition, the mean slope of renal decline was similar in diabetic and non-diabetic patients when controlling for albuminuria. The urinary albumin-creatinine ratio was a robust predictor of poor outcome in uni- and multivariate models. In the diabetic group, time-varying glycosilated haemoglobin did not influence renal outcome in the Cox model, and time-varying albuminuria remained a strong predictor of outcome.Conclusions. Diabetic patients have a poorer renal outcome, but at comparable levels of albuminuria renal decline is similar in diabetic and non-diabetic patients. Albuminuria is a risk factor for renal decline, and the main target to delay progression in patients, diabetics or non-diabetics, with moderate to advanced CKD.