Jiyugaoka Medical Clinic, Internal Medicine, West 6, South 6-4-3, Obihiro 080-0016, Japan.
Diabetologia. 2012 Jul;55(7):1911-8. doi: 10.1007/s00125-012-2536-y. Epub 2012 Apr 4.
AIMS/HYPOTHESIS: In type 2 diabetic patients at low risk for cardiovascular disease (CVD), the relationship between the clinical course of nephropathy by stage of chronic kidney disease (CKD) and onset of CVD remains unclear. Clarification of this relationship is important for clinical decision-making for both low- and high-risk diabetic patients.
This 4 year prospective study enrolled 2,954 type 2 diabetic patients with no prevalent CVD, and serum creatinine <176.8 μmol/l. The risk for CVD onset (non-fatal and fatal CVD and stroke, and peripheral arterial disease) was assessed according to CKD stage categorised by urinary albumin-to-creatinine ratio (ACR; mg/mmol) and estimated GFR (eGFR; ml min(-1) 1.73 m(-2)). Association of progression from 'no CKD' stage (ACR <3.5 mg/mmol and eGFR ≥ 90 ml min(-1) 1.73 m(-2)) with risk for CVD onset was also evaluated.
During follow-up (median 3.8 years), 89 CVD events occurred. Compared with patients with 'no CKD' as reference, those with ACR ≥ 35.0 mg/mmol with co-existing eGFR 60-89 ml min(-1) 1.73 m(-2) or <60 ml min(-1) 1.73 m(-2) showed increased risk for CVD onset, whereas those with eGFR ≥ 90 ml min(-1) 1.73 m(-2) did not. Those with ACR <3.5 mg/mmol and eGFR <60 ml min(-1) 1.73 m(-2) did not show any increased risk. Among patients with 'no CKD' stage at baseline, those who progressed to ACR ≥ 3.5 mg/mmol during follow-up showed an increased risk compared with those who did not, whereas those who progressed to eGFR <90 ml min(-1) 1.73 m(-2) did not have increased risk.
CONCLUSIONS/INTERPRETATION: The risk for CVD was associated with progression of albuminuria stage rather than eGFR stage in type 2 diabetic patients at relatively low risk for CVD.
目的/假设：在心血管疾病（CVD）风险较低的 2 型糖尿病患者中，肾病的临床病程与 CKD 阶段以及 CVD 的发病之间的关系尚不清楚。明确这种关系对于低风险和高风险糖尿病患者的临床决策都很重要。
这项为期 4 年的前瞻性研究纳入了 2954 名无既往 CVD 且血清肌酐<176.8 μmol/l 的 2 型糖尿病患者。根据尿白蛋白与肌酐比值（ACR；mg/mmol）和估算肾小球滤过率（eGFR；ml min(-1) 1.73 m(-2)）将 CKD 分为不同阶段，评估 CVD 发病的风险（非致命性和致命性 CVD 和中风，以及外周动脉疾病）。还评估了从“无 CKD”阶段（ACR <3.5 mg/mmol 和 eGFR≥90 ml min(-1) 1.73 m(-2)）进展与 CVD 发病风险的关系。
在随访期间（中位 3.8 年），发生了 89 例 CVD 事件。与以“无 CKD”为参照的患者相比，ACR≥35.0 mg/mmol 且同时存在 eGFR 60-89 ml min(-1) 1.73 m(-2)或<60 ml min(-1) 1.73 m(-2)的患者，CVD 发病风险增加，而 eGFR≥90 ml min(-1) 1.73 m(-2)的患者则没有。ACR<3.5 mg/mmol 且 eGFR<60 ml min(-1) 1.73 m(-2)的患者没有任何增加的风险。在基线时处于“无 CKD”阶段的患者中，与未进展的患者相比，随访期间进展为 ACR≥3.5 mg/mmol 的患者风险增加，而进展为 eGFR<90 ml min(-1) 1.73 m(-2)的患者则没有增加的风险。
结论/解释：在 CVD 风险相对较低的 2 型糖尿病患者中，CVD 风险与蛋白尿阶段的进展有关，而与 eGFR 阶段无关。
