Death, end-stage renal disease and renal function decline in patients with diabetic nephropathy in French cohorts of type 1 and type 2 diabetes
Death, end-stage renal disease and renal function decline in patients with diabetic nephropathy in French cohorts of type 1 and type 2 diabetes
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DOI：
10.1007/s00125-015-3785-3
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发表时间：
2016-01-01
期刊：
影响因子：
8.2
通讯作者：
Marre, Michel
中科院分区：
文献类型：
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作者：
Hadjadj, Samy;Cariou, Bertrand;Marre, Michel
目的/假设微血管并发症是糖尿病的共同特征，但需要对1型和2型糖尿病肾病终点进行进一步研究。方法：我们比较了277例1型糖尿病患者和942例2型糖尿病患者，这些患者在基线时有蛋白尿且无终末期肾病（ESRD），并对死亡、ESRD和估计肾小球滤过率（eGFR）的下降进行了前瞻性随访。结果2型糖尿病和1型糖尿病的死亡率分别为67.0 （95% CI 59.2, 74.8）和24.6 (95% CI 19.0, 30.2) / 1000患者-年。2型糖尿病患者未调整的死亡风险更高（HR 3.423; 95% CI, 2.501, 4.683; p < 0.0001），但调整年龄后差异不存在（HRage-adj 0.859; 95% CI, 0.581, 1.269; p = 0.445）。2型糖尿病和1型糖尿病的ESRD发病率分别为每1000患者年18.4 （95% CI 14.2, 22.5）和47.1 （95% CI 38.4, 55.9）。2型糖尿病患者发生ESRD的未调整风险较低（HR 0.399; 95% CI 0.287, 0.554; p < 0.0001），但在调整性别、年龄和基线血清肌酐后，差异不存在（HRadj 0.989; 95% CI 0.597, 1.639; p = 0.965）。在混合线性模型中，2型糖尿病与1型糖尿病的eGFR下降无显著差异(斜率差为-0.19 [0.28]ml min(-1) 1.73 m(-2) year(-1)；P = 0.512)。结论/解释在糖尿病肾病中，一旦考虑到死亡风险的基线危险因素，ESRD和肾功能下降在1型糖尿病和2型糖尿病之间没有显著差异。
Aims/hypothesis Microvascular complications are a common feature of diabetes but additional research is needed regarding diabetic nephropathy endpoints in type 1 and type 2 diabetes.Methods We compared 277 type 1 diabetes patients with 942 type 2 diabetes patients, with clinical proteinuria and no end-stage renal disease (ESRD) at baseline, prospectively followed for death, ESRD and decline in estimated glomerular filtration rate (eGFR, all available measures).Results The incidence rate of death was 67.0 (95% CI 59.2, 74.8) vs 24.6 (95% CI, 19.0, 30.2) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for death was greater for type 2 diabetes patients (HR 3.423; 95% CI, 2.501, 4.683; p < 0.0001), but the difference did not persist after adjustment for age (HRage-adj 0.859; 95% CI 0.581, 1.269; p = 0.445). The incidence rate of ESRD was 18.4 (95% CI 14.2, 22.5) vs 47.1 (95% CI 38.4, 55.9) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for ESRD was lower in type 2 diabetes (HR 0.399; 95% CI 0.287, 0.554; p < 0.0001), but the difference did not persist after adjustment for sex, age and baseline serum creatinine (HRadj 0.989; 95% CI 0.597, 1.639; p = 0.965). In a mixed linear model, eGFR decline was not significantly different in type 2 vs type 1 diabetes (difference in slope -0.19 [0.28] ml min(-1) 1.73 m(-2) year(-1); p = 0.512).Conclusions/interpretation In diabetic nephropathy, once baseline risk factors were taken into account the risk for death, ESRD and renal function decline did not significantly differ between type 1 diabetes and type 2 diabetes.