2 型糖尿病合并冠心病患者肾功能障碍的高患病率和多样性：BARI 2D 基线数据。
High prevalence and diversity of kidney dysfunction in patients with type 2 diabetes mellitus and coronary artery disease: the BARI 2D baseline data.
机构信息
Veterans Affairs Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee 38104, USA.
出版信息
Am J Med Sci. 2010 May;339(5):401-10. doi: 10.1097/MAJ.0b013e3181d430ad.
BACKGROUND
We describe baseline renal function and albumin excretion rate in patients enrolled in Bypass Angioplasty Revascularization Investigation 2 Diabetes, a randomized clinical trial comparing the impact of revascularization and medical therapy with medical therapy alone and deferred or no revascularization and the impact of glycemic control with either insulin-providing or insulin-sensitizing drugs, on 5-year mortality.
METHODS
Study participants had type 2 diabetes mellitus, documented coronary artery disease, and creatinine <2 mg/dL. Albuminuria status (albumin/creatinine ratio [ACR]) and estimated glomerular filtration rate (eGFR), using the abbreviated Modified Diet in Renal Disease equation, were determined at baseline. Univariate and multivariate relationships between baseline clinical characteristics and the presence of albuminuria and reduced eGFR rate were estimated.
RESULTS
Two thousand one hundred forty-six subjects were included in the analysis. Forty-three percent of the cohort had evidence of kidney dysfunction at baseline: 23% had an eGFR > or =60 mL/min/1.73 m with either microalbuminuria ( >30 ACR; 17%) or macroalbuminuria (>300 ACR; 6%). Twenty-one percent had a reduced eGFR <60 mL/min/1.73 m; 52% with reduced eGFR had no albuminuria; 28% had microalbuminuria, and 20% had macroalbuminuria. Race, smoking status, duration of diabetes, hypertension, hemoglobin A1c, triglycerides, vascular disease, abnormal ejection fraction, and reduced eGFR were associated with greater albuminuria. Age, sex, duration of diabetes, ACR, hemoglobin A1c, high density lipoprotein, and number of hypertensive medications were associated with reduced eGFR.
CONCLUSION
Kidney dysfunction is common in older patients with type 2 diabetes mellitus and coronary artery disease; Albuminuria was present in 33%. Reduced eGFR was present in 21%, and half the patients with reduced eGFR had no evidence of albuminuria.
背景
我们描述了 Bypass Angioplasty Revascularization Investigation 2 Diabetes 研究中入组患者的基线肾功能和白蛋白排泄率，这是一项随机临床试验，比较了血运重建和单纯药物治疗以及延迟或不进行血运重建以及使用胰岛素提供或胰岛素增敏药物控制血糖对 5 年死亡率的影响。
方法
研究参与者患有 2 型糖尿病、有记录的冠心病和肌酐 <2 mg/dL。基线时使用简化的肾脏病饮食改良公式（abbreviated Modified Diet in Renal Disease equation）确定白蛋白尿状态（白蛋白/肌酐比值[ACR]）和估算肾小球滤过率（eGFR）。使用单变量和多变量方法估计基线临床特征与白蛋白尿和 eGFR 降低率之间的关系。
结果
2146 名患者纳入分析。队列中有 43%的患者在基线时存在肾功能障碍证据：23%的患者 eGFR >或=60 mL/min/1.73 m，伴有微量白蛋白尿（>30 ACR；17%）或大量白蛋白尿（>300 ACR；6%）。21%的患者 eGFR 降低<60 mL/min/1.73 m；52%的 eGFR 降低患者无白蛋白尿；28%的患者有微量白蛋白尿，20%的患者有大量白蛋白尿。种族、吸烟状况、糖尿病病程、高血压、糖化血红蛋白、甘油三酯、血管疾病、射血分数异常和 eGFR 降低与更大程度的白蛋白尿相关。年龄、性别、糖尿病病程、ACR、糖化血红蛋白、高密度脂蛋白和高血压药物的数量与 eGFR 降低相关。
结论
2 型糖尿病和冠心病老年患者常见肾功能障碍；33%的患者存在白蛋白尿。21%的患者存在 eGFR 降低，而一半的 eGFR 降低患者没有白蛋白尿的证据。
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