2 型糖尿病患者慢性肾脏病分期与大血管疾病风险：估计肾小球滤过率的临界水平和高尿酸血症的意义。
Risk of macrovascular disease stratified by stage of chronic kidney disease in type 2 diabetic patients: critical level of the estimated glomerular filtration rate and the significance of hyperuricemia.
机构信息
Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.
Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
出版信息
Clin Exp Nephrol. 2011 Jun;15(3):391-397. doi: 10.1007/s10157-011-0420-6. Epub 2011 Feb 18.
BACKGROUND
Although a high prevalence of macrovascular disease (MVD) has been reported in patients with stage 3 chronic kidney disease (CKD), few studies have reported its risk with respect to the underlying cause of kidney disease. This study investigated the prevalence of MVD in type 2 diabetic patients with CKD stratified by CKD stage, as defined by estimated glomerular filtration rate (eGFR), as well as the risk factors for MVD.
METHODS
1493 patients with diabetic CKD (1273 males, 220 females) were stratified by CKD stage (stage 1: 39, stage 2: 272, stage 3: 1052, stage 4: 101, stage 5: 29) based on eGFR calculated by the Japanese formula and averaged over 8 months. MVD was defined as one of the following: coronary heart disease (CHD), stroke or arteriosclerosis obliterans (ASO).
RESULTS
The prevalence of MVD was 18.6%. A significant increasing trend in MVD prevalence was observed from stage 3 (17.78%) to 4 (52.48%). According to a receiver operating characteristic curve analysis on MVD prevalence in stage 3 patients, an eGFR of 46.4 ml/min/1.73 m(2) was determined to be a critical cut-off level. Proteinuria, eGFR <60 ml/min/1.73 m(2) and hyperuricemia were independent risk factors for MVD.
CONCLUSIONS
In patients with diabetic CKD, a significant increase in MVD prevalence was observed from stage 3 to 4. An eGFR of 46.4 ml/min/1.73 m(2) is a critical level that affects MVD prevalence. From the perspective of cardiorenal association, CKD stage 3 should be divided into two substages. As hyperuricemia is related to an increased risk of MVD, uric acid control may be important in reducing MVD risk in diabetic CKD.
背景
尽管已有研究报道，在患有 3 期慢性肾脏病（CKD）的患者中，大血管疾病（MVD）的患病率较高，但很少有研究报告其与肾脏疾病的潜在病因之间的风险关系。本研究旨在调查根据估算肾小球滤过率（eGFR）定义的 CKD 分期（1 期：39 例，2 期：272 例，3 期：1052 例，4 期：101 例，5 期：29 例），将 2 型糖尿病合并 CKD 患者的 MVD 患病率分层，并分析 MVD 的危险因素。
方法
根据日本公式计算并平均 8 个月的 eGFR 将 1493 例糖尿病 CKD 患者（男 1273 例，女 220 例）分层为 CKD 分期（1 期：39 例，2 期：272 例，3 期：1052 例，4 期：101 例，5 期：29 例）。MVD 定义为以下之一：冠心病（CHD）、中风或动脉硬化闭塞症（ASO）。
结果
MVD 的患病率为 18.6%。MVD 患病率从 3 期（17.78%）到 4 期（52.48%）呈显著递增趋势。根据 3 期患者 MVD 患病率的受试者工作特征曲线分析，46.4ml/min/1.73m2的 eGFR 被确定为临界截止值。蛋白尿、eGFR <60ml/min/1.73m2和高尿酸血症是 MVD 的独立危险因素。
结论
在患有糖尿病 CKD 的患者中，从 3 期到 4 期 MVD 的患病率显著增加。46.4ml/min/1.73m2 的 eGFR 是影响 MVD 患病率的临界水平。从心肾关联的角度来看，CKD 3 期应分为两个亚期。由于高尿酸血症与 MVD 风险增加相关，因此控制尿酸可能对降低糖尿病 CKD 患者的 MVD 风险很重要。
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