Shankar A, Klein R, Klein B E K, Moss S E
Division of Epidemiology, Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Exp Clin Endocrinol Diabetes. 2007 Mar;115(3):203-6. doi: 10.1055/s-2007-956170.
The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes.
To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes.
Prospective cohort study of type 1 diabetes individuals.
Community based in southwestern Wisconsin.
547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86).
Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m(2) or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD.
After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD.
Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.
1型糖尿病中近期定义的慢性肾脏病（CKD）结局发生率尚未得到广泛报道。
探讨1型糖尿病患者基线糖化血红蛋白水平与CKD及终末期肾病（ESRD）16年发病率之间的前瞻性关联。
1型糖尿病患者的前瞻性队列研究。
威斯康星州西南部的社区。
547例基线时（1984 - 1986年）无CKD的早发型1型糖尿病患者。
在基线时无CKD的个体中，随访16年期间CKD的发生情况（定义为估计肾小球滤过率<60 ml/min/1.73 m²或ESRD [透析或肾移植病史]）。替代结局为16年新发ESRD。
随访16年后，我们的队列中有158例CKD病例和37例ESRD病例。CKD的16年累积发病率为31.7%。在单独的模型中，糖化血红蛋白水平升高与新发CKD和ESRD相关。将糖化血红蛋白最高四分位数（11 - 15.3%）与最低四分位数（6 - 8.6%）进行比较的多变量优势比（OR）[95%置信区间（CI）]，新发CKD为6.44（3.61 - 11.51），p趋势<0.0001；新发ESRD为21.87（2.84 - 168.39），p趋势<0.0001。
在1型糖尿病患者中，较高的基线糖化血红蛋白水平与新发CKD和ESRD独立相关。
