Bulum Tomislav, Kolarić Branko, Prkacin Ingrid, Duvnjak Lea
University of Zagreb, School of Medicine, "Merkur" University Hospital, "Vuk Vrhovac" Clinic for Diabetes, Endocrinology and Metabolic Diseases, Zagreb, Croatia.
Coll Antropol. 2013 Jun;37(2):471-6.
Hyperfiltration has been documented in type 1 diabetes and may contribute to the high risk for development of albuminuria and progression of nephropathy. However, recent studies suggest that the risk of progression to albuminuria in type 1 diabetes was not increased by hyperfiltration. We investigated associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (UAE) in normoalbuminuric type 1 diabetic patients. Study included 313 normoalbuminuric patients with type 1 diabetes, none showed signs of adrenal, renal, or cardiovascular diseases. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Glomerular hyperfiltration was defined as eGFR > or = 125 mL min(-1) 1.73 m(-2). Renal hyperfiltration was present in 12% of the study group. Subjects with eGFR > or = 125 mL min(-1) 1.73 m(-2) were younger, had shorter duration of diabetes, lower levels of total and LDL cholesterol, and higher HbA1c than subjects with an eGFR below 125 mL min(-1) 1.73 m(-2). Type 1 diabetic patients with hyperfiltration also had significantly lower UAE. In a multiple logistic regression analysis, higher eGFR was associated with lower UAE. Our results indicate that normoalbuminuric type 1 diabetic patients with hyperfiltration have lower UAE than those with renal function in the normal range. Together with other recent studies this may suggest that creatinine-based estimates of GFR indicating hyperfiltration is not associated with higher UAE and subsequent development of microalbuminuria.
在1型糖尿病患者中已证实存在超滤现象，这可能是蛋白尿发生风险高及肾病进展的原因之一。然而，最近的研究表明，超滤并不会增加1型糖尿病患者进展为蛋白尿的风险。我们研究了正常白蛋白尿的1型糖尿病患者的估计肾小球滤过率（eGFR）与尿白蛋白排泄率（UAE）之间的关系。研究纳入了313例正常白蛋白尿的1型糖尿病患者，这些患者均无肾上腺、肾脏或心血管疾病的迹象。使用慢性肾脏病流行病学协作组（CKD-EPI）公式估算肾小球滤过率。肾小球超滤定义为eGFR≥125 mL·min⁻¹·1.73 m⁻²。研究组中有12%的患者存在肾脏超滤。与eGFR低于125 mL·min⁻¹·1.73 m⁻²的患者相比，eGFR≥125 mL·min⁻¹·1.73 m⁻²的患者更年轻，糖尿病病程更短，总胆固醇和低密度脂蛋白胆固醇水平更低，糖化血红蛋白（HbA1c）更高。超滤的1型糖尿病患者的UAE也显著更低。在多元逻辑回归分析中，较高的eGFR与较低的UAE相关。我们的结果表明，超滤的正常白蛋白尿1型糖尿病患者的UAE低于肾功能在正常范围内的患者。与其他近期研究一起，这可能表明基于肌酐的GFR估算值显示超滤与较高的UAE及随后微量白蛋白尿的发生无关。
