Dyck Roland F, Sidhu Nirmal, Klomp Helena, Cascagnette Paul J, Teare Gary F
Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan.
Clin Invest Med. 2010 Dec 1;33(6):E390-7. doi: 10.25011/cim.v33i6.14590.
Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and other Saskatchewan residents (OSK) by renal function stage.
Prevalent diabetes cases in 2005/06 were identified in Saskatchewan's two largest health regions using administrative databases, and linked with centralized laboratory tests. They were sub-divided into five stages of renal function using estimated glomerular filtration rates (eGFR) that were determined in 992 of 2,321 FN (42.7%) and 14,054 of 21,886 OSK (64.2%). Age, sex, urine microalbumin (MA), glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C) and two year mortality risk was compared for all subjects.
Diabetic FN were younger (mean age 52.7 vs. 64.2, p < 0.0001), more likely to be female (59.6% vs.45.4%, p < 0.001), had increased MA (56.6% vs. 48.4%, p < 0.0001) and displayed higher mean A1C levels (8.16% vs.7.36%, p < 0.0001) than OSK. Despite a larger proportion having eGFR's > 60 ml/min (87.0% vs.77.3%, p < 0.001), FN were also more likely to have ESRD (2.3% vs.0.8%, p < 0.001). Although FN with eGFR's > 30 ml/min experienced higher age/sex adjusted mortality risk than OSK, the trends for both adjusted and unadjusted mortality risks for those with advanced pre-ESRD renal failure were lower for FN than for OSK.
Elevated rates of ESRD experienced by FN with diabetes are related to poorer glycemic control at all levels of renal function, and lower age-related mortality at advanced stages of chronic kidney disease.
糖尿病原住民（FN）的终末期肾病（ESRD）发病率高于其他加拿大人，但原因尚不清楚。我们试图通过比较糖尿病FN和萨斯喀彻温省其他居民（OSK）在肾功能阶段的人口统计学、实验室检查和生存特征，来更好地理解这种差异。
利用行政数据库在萨斯喀彻温省两个最大的健康区域确定2005/06年的糖尿病现患病例，并与集中的实验室检查结果相联系。使用估计肾小球滤过率（eGFR）将其分为五个肾功能阶段，2321名FN中的992名（42.7%）和21886名OSK中的14054名（64.2%）测定了eGFR。比较了所有受试者的年龄、性别、尿微量白蛋白（MA）、糖化血红蛋白（A1C）、低密度脂蛋白胆固醇（LDL-C）和两年死亡风险。
糖尿病FN较年轻（平均年龄52.7岁对64.2岁，p<0.0001），女性比例更高（59.6%对45.4%，p<0.001），MA升高（56.6%对48.4%，p<0.0001），且平均A1C水平高于OSK（8.16%对7.36%，p<0.0001）。尽管eGFR>60 ml/min的比例更高（87.0%对77.3%，p<0.001），但FN患ESRD的可能性也更高（2.3%对0.8%，p<0.001）。尽管eGFR>30 ml/min的FN比OSK经历更高的年龄/性别调整死亡风险，但对于ESRD前期肾衰竭患者，FN的调整和未调整死亡风险趋势均低于OSK。
糖尿病FN的ESRD发病率升高与肾功能各阶段血糖控制较差以及慢性肾病晚期年龄相关死亡率较低有关。
