Yokoyama Hiroki, Kanno Sakiko, Takahashi Suguho, Yamada Daishiro, Itoh Hiroshi, Saito Kazumi, Sone Hirohito, Haneda Masakazu
Jiyugaoka Medical Clinic, Internal Medicine, Obihiro 080-0016, Japan.
Clin J Am Soc Nephrol. 2009 Sep;4(9):1432-40. doi: 10.2215/CJN.06511208.
This study investigated whether the slope of estimated GFR is different between nonproteinuric subjects with and without diabetes, and what clinical factors are associated with the GFR slope.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An observational cohort study was performed in 923 subjects, and the predictive value of baseline variables on the GFR slope was investigated.
On the basis of the median 3-yr follow-up and 7 measurements of GFR, GFR slope (%/yr, median and interquartile range) was significantly larger in subjects with diabetes (-2.39 (-4.86 to 0.15), n=729) than in those without diabetes (-1.02 (-4.28 to 1.37), n=194), and this difference remained significant with or without presence of hypertension. After adjustments for confounding factors, predictors of GFR decline were found to be baseline high values of glycosylated hemoglobin A1C(HbA1C), GFR, systolic blood pressure, and low plasma total protein in subjects with diabetes, whereas only the latter two were significant in subjects without diabetes. In subjects with diabetes, the high GFR was accounted for by high HbA1C at baseline, and the predictors of GFR decline differed between those with and without hypertension, or with high and low baseline GFR. Any combination of the predictors showed increased risk for GFR decline.
GFR slope is substantially affected by multiple factors at various stages. The degree of chronic hyperglycemia is likely to play a crucial role in elevating GFR and accelerating the decline in patients with type 2 diabetes even from the normoalbuminuric stage.
本研究调查了非蛋白尿患者中患糖尿病与未患糖尿病者的估算肾小球滤过率（GFR）斜率是否存在差异，以及哪些临床因素与GFR斜率相关。
设计、地点、参与者及测量方法：对923名受试者进行了一项观察性队列研究，并调查了基线变量对GFR斜率的预测价值。
基于3年的中位随访期及7次GFR测量结果，糖尿病患者（n = 729）的GFR斜率（%/年，中位数及四分位间距）显著高于未患糖尿病者（n = 194），分别为-2.39（-4.86至0.15）和-1.02（-4.28至1.37），无论有无高血压，这种差异均显著。在对混杂因素进行校正后，发现糖尿病患者GFR下降的预测因素为糖化血红蛋白A1C（HbA1C）、GFR、收缩压的基线高值以及低血浆总蛋白，而在未患糖尿病者中只有后两者具有显著性。在糖尿病患者中，高GFR由基线时的高HbA1C所致，且GFR下降的预测因素在有高血压与无高血压者之间，或基线GFR高与低者之间存在差异。任何预测因素的组合均显示GFR下降风险增加。
GFR斜率在不同阶段受到多种因素的显著影响。即使在正常白蛋白尿阶段，慢性高血糖程度可能在2型糖尿病患者中升高GFR及加速其下降方面起关键作用。
