Department of Endocrinology and Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Nephrol Dial Transplant. 2009 Dec;24(12):3724-31. doi: 10.1093/ndt/gfp349. Epub 2009 Jul 17.
Diabetes is a major risk factor for the development of kidney disease. We aimed to determine the prevalence of albuminuria and chronic kidney disease (CKD) in Chinese subjects with diabetes and pre-diabetes and the risk factors for kidney disease.
An urban community-based sample of 3714 adults in Shanghai was classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes. The estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (ACR) were applied to designate renal function and albuminuria, respectively. Binary logistic regression was performed to analyse the contribution of risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR.
The prevalence of microalbuminuria, macroalbuminuria and CKD in subjects with diabetes was 22.8%, 3.4% and 29.6%, respectively, which was significantly higher than that in non-diabetes subjects. After adjustment for age, the odds ratio of hypertension for albuminuria and renal insufficiency (eGFR <60 mL/min/1.73 m(2,) stages 3-5 of CKD) were 1.23 (P = 0.000) and 2.55 (P = 0.000). Diabetes and cardiovascular disease (CVD) both increased the risk for albuminuria significantly, with the odds ratio of 1.22 (P = 0.04) and 1.36 (P = 0.006), respectively. Diabetes and CVD were not independent risk factor for renal insufficiency. Although the worsening trends of eGFR are similar in diabetes and IGR subjects, IGR was not a significant risk factor for albuminuria and renal insufficiency.
Screening for albuminuria and eGFR is highly recommended for older patients with diabetes, hypertension and CVD to prevent end-stage kidney disease.
糖尿病是导致肾脏疾病的主要危险因素。我们旨在确定中国糖尿病和糖尿病前期患者白蛋白尿和慢性肾脏病（CKD）的患病率，以及肾脏病的危险因素。
在上海进行了一项基于城市社区的样本调查，共纳入 3714 名成年人，分为正常血糖耐量（NGT）、糖调节受损（IGR）和糖尿病。应用估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）分别指定肾功能和白蛋白尿。采用二元逻辑回归分析危险因素对 CKD 的贡献。多项式回归用于确定 eGFR 随 ACR 增量的趋势。
糖尿病患者的微量白蛋白尿、大量白蛋白尿和 CKD 的患病率分别为 22.8%、3.4%和 29.6%，显著高于非糖尿病患者。调整年龄后，高血压对白蛋白尿和肾功能不全（eGFR<60 mL/min/1.73 m(2)，CKD 第 3-5 期）的优势比分别为 1.23（P=0.000）和 2.55（P=0.000）。糖尿病和心血管疾病（CVD）均显著增加白蛋白尿的风险，优势比分别为 1.22（P=0.04）和 1.36（P=0.006）。糖尿病和 CVD 不是肾功能不全的独立危险因素。尽管糖尿病和 IGR 患者的 eGFR 恶化趋势相似，但 IGR 不是白蛋白尿和肾功能不全的显著危险因素。
对于患有糖尿病、高血压和 CVD 的老年患者，建议筛查白蛋白尿和 eGFR，以预防终末期肾脏疾病。
