Parving H-H, Lewis J B, Ravid M, Remuzzi G, Hunsicker L G
Steno Diabetes Center, Copenhagen, Denmark.
Kidney Int. 2006 Jun;69(11):2057-63. doi: 10.1038/sj.ki.5000377.
We described the characteristics in a referred cohort of type II diabetic patients in the Developing Education on Microalbuminuria for Awareness of renal and cardiovascular risk in Diabetes study evaluating the global prevalence and determinants of microalbuminuria (MA). A cross-sectional study evaluating 32,208 type II diabetic patients without known albuminuria from 33 countries was performed. Overall, 8057 patients were excluded, either because of prior known proteinuria or non-diabetic nephropathy (3670), or because of invalid urine collections (4387). One single random urinary albumin/creatinine ratio was obtained in 24,151 patients (75%). The overall global prevalence of normo-, micro-, and macroalbuminuria was 51, 39, and 10%, respectively. The Asian and Hispanic patients had the highest prevalence of a raised urinary albumin/creatinine ratio (55%) and Caucasians the lowest (40.6), P<0.0001. HbA1c, systolic blood pressure (BP), ethnicity, retinopathy, duration of diabetes, kidney function, body height, and smoking were all independent risk factors of MA, P<0.0001. Estimated glomerular filtration rate was below 60 ml/min/1.73 m(2) in 22% of the 11,573 patients with available data. Systolic BP below 130 mmHg was found in 33 and 43% had an HbA1c below 7%. The frequency of patients receiving aspirin was 32%, statins 29%, and BP-lowering therapy 63%. A high prevalence globally of MA and reduced kidney function, both conditions associated with enhanced renal and cardiovascular risk, was detected in type II diabetic patients without prior known nephropathy. Early detection, monitoring of vascular complications, and more aggressive multifactorial treatment aiming at renal and vascular protection are urgently needed.
在“糖尿病中微量白蛋白尿知晓以预防肾脏和心血管风险的发展教育”（Developing Education on Microalbuminuria for Awareness of renal and cardiovascular risk in Diabetes）研究中，我们描述了一组转诊的II型糖尿病患者的特征，该研究评估了微量白蛋白尿（MA）的全球患病率及其决定因素。我们进行了一项横断面研究，评估了来自33个国家的32208例无已知白蛋白尿的II型糖尿病患者。总体而言，8057例患者被排除，其中3670例是因为既往已知蛋白尿或非糖尿病肾病，4387例是因为尿液收集无效。24151例患者（75%）获得了单次随机尿白蛋白/肌酐比值。正常白蛋白尿、微量白蛋白尿和大量白蛋白尿的总体全球患病率分别为51%、39%和10%。亚洲和西班牙裔患者尿白蛋白/肌酐比值升高的患病率最高（55%），白种人最低（40.6%），P<0.0001。糖化血红蛋白（HbA1c）、收缩压（BP）、种族、视网膜病变、糖尿病病程、肾功能、身高和吸烟均为MA的独立危险因素，P<0.0001。在有可用数据的11573例患者中，22%的估计肾小球滤过率低于60 ml/min/1.73 m²。收缩压低于130 mmHg的患者占33%，糖化血红蛋白低于7%的患者占43%。接受阿司匹林治疗的患者频率为32%，他汀类药物为29%，降压治疗为63%。在无既往已知肾病的II型糖尿病患者中，全球MA患病率高且肾功能降低，这两种情况均与肾脏和心血管风险增加相关。迫切需要进行早期检测、监测血管并发症，并采取更积极的多因素治疗以保护肾脏和血管。
