Merck Sharp & Dohme Corp., Whitehouse Station, NJ Amgen Inc, Thousand Oaks, CA, USA.
Diabet Med. 2012 May;29(5):614-21. doi: 10.1111/j.1464-5491.2011.03498.x.
Progressive decline in renal function has been well described in patients with Type 2 diabetes mellitus, but few studies have assessed the risk of acute renal failure in a large population of patients with Type 2 diabetes. This study quantified the risk of acute renal failure associated with Type 2 diabetes in the General Practice Research Database from the UK.
Patients with Type 2 diabetes (n = 119,966) and patients without diabetes (n = 1,794,516) were identified in the General Practice Research Database. Patients with end-stage renal disease were excluded. Crude incidence and multivariate-adjusted hazard ratios of acute renal failure were estimated for patients with diabetes relative to those without diabetes. Cox regression models were adjusted for a variety of comorbidities. Increase of acute renal failure risk resulting from additive effects of specific co-morbidities with Type 2 diabetes was also assessed.
Between 2003 and 2007, acute renal failure incidence was 198 per 100,000 person-years in patients with Type 2 diabetes compared with 27 per 100,000 patients-years among patients without diabetes (crude hazard ratio 8.0, 95% CI 7.4-8.7). Risk of acute renal failure for patients with Type 2 diabetes remained significant, but was attenuated in multivariate analyses adjusting for various comorbidities (adjusted hazard ratio 2.5, 95% CI 2.2-2.7). Age and specific comorbidities (chronic kidney disease, hypertension and congestive heart failure) were also associated with increased risk of acute renal failure in Type 2 diabetes.
Patients with Type 2 diabetes have increased risk for acute renal failure compared with patients without diabetes, even after adjustment for known risk factors, particularly in the elderly and those with other comorbidities such as chronic kidney disease, congestive heart failure and hypertension.
2 型糖尿病患者的肾功能逐渐下降已得到充分描述，但很少有研究在 2 型糖尿病的大量患者中评估急性肾衰竭的风险。本研究在英国的全科医学研究数据库中定量评估了 2 型糖尿病患者发生急性肾衰竭的风险。
在全科医学研究数据库中确定了 2 型糖尿病患者（n=119966）和无糖尿病患者（n=1794516）。排除终末期肾病患者。估计了糖尿病患者与无糖尿病患者相比发生急性肾衰竭的粗发病率和多变量校正后的危险比。Cox 回归模型调整了各种合并症。还评估了特定合并症与 2 型糖尿病的累加效应对急性肾衰竭风险增加的影响。
在 2003 年至 2007 年期间，2 型糖尿病患者的急性肾衰竭发生率为每 100000 人年 198 例，而无糖尿病患者为每 100000 人年 27 例（粗危险比 8.0，95%CI 7.4-8.7）。在调整了各种合并症后，2 型糖尿病患者发生急性肾衰竭的风险仍然显著，但有所减弱（调整后的危险比 2.5，95%CI 2.2-2.7）。年龄和特定合并症（慢性肾脏病、高血压和充血性心力衰竭）也与 2 型糖尿病患者急性肾衰竭风险增加相关。
与无糖尿病患者相比，2 型糖尿病患者发生急性肾衰竭的风险增加，即使在调整了已知危险因素后，尤其是在老年人和患有其他合并症（如慢性肾脏病、充血性心力衰竭和高血压）的患者中。
