性别对2型糖尿病患者肾功能衰退的影响。

The influence of sex on renal function decline in people with Type 2 diabetes.

作者信息

de Hauteclocque A, Ragot S, Slaoui Y, Gand E, Miot A, Sosner P, Halimi J-M, Zaoui P, Rigalleau V, Roussel R, Saulnier P-J, Hadjadj Samy S

机构信息

CIC 1402, Inserm, Paris.

出版信息

Diabet Med. 2014 Sep;31(9):1121-8. doi: 10.1111/dme.12478. Epub 2014 May 21.

DOI:10.1111/dme.12478

PMID:24773061

Abstract

AIMS

Several reports have suggested a relationship between male sex and albuminuria in Type 2 diabetes, but impact on renal function decline has not been established. Our aim was to describe the influence of sex on renal function decline in Type 2 diabetes.

METHODS

SURDIAGENE, an inception cohort, consisted in 1470 people with Type 2 diabetes. Patients without renal replacement therapy and with ≥ 3 serum creatinine determinations during follow-up prior to end-stage renal disease were included in the study. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Primary outcome was steep estimated glomerular filtration rate (eGFR) decline, defined as a yearly slope value lower than -3.5 ml min(-1) 1.73 m(-2). Secondary outcomes were estimated glomerular filtration rate trajectories according to sex and occurrence of end-stage renal disease.

RESULTS

A total of 22 914 serum creatinine determinations were considered in 1146 participants (60% men), aged 65 ± 11 years, with a median follow-up duration of 5.7 years (range 0.1-10.2). Median yearly estimated glomerular filtration rate slope was -1.31 ml min(-1) 1.73 m(-2) in women and -1.77 ml min(-1) 1.73 m(-2) in men (P < 0.001). Men were more likely than women to develop end-stage renal disease (22 men vs. 7 women; P(log-rank) = 0.03). Male sex was an independent risk factor of steep estimated glomerular filtration rate decline [adjusted odds ratio = 1.33 (1.02-1.76), P = 0.04] after adjustment for age, time from diagnosis of Type 2 diabetes, glycated haemoglobin, systolic blood pressure and urinary albumin:creatinine ratio. A multivariable linear mixed-effects model showed a significant difference of estimated glomerular filtration rate trajectories between men and women (P < 0.001).

CONCLUSION

Male sex is an important independent factor associated with renal function decline in Type 2 diabetes.

摘要

目的

多项报告提示2型糖尿病患者中男性与蛋白尿之间存在关联，但对肾功能下降的影响尚未明确。我们的目的是描述性别对2型糖尿病患者肾功能下降的影响。

方法

SURDIAGENE是一个起始队列，由1470例2型糖尿病患者组成。纳入研究的患者为未接受肾脏替代治疗且在随访期间终末期肾病之前有≥3次血清肌酐测定结果者。采用慢性肾脏病流行病学协作组方程计算估计肾小球滤过率。主要结局是估计肾小球滤过率（eGFR）急剧下降，定义为年斜率值低于-3.5 ml·min⁻¹·1.73 m⁻²。次要结局是根据性别划分的估计肾小球滤过率轨迹以及终末期肾病的发生情况。

结果

1146例参与者（60%为男性）共进行了22914次血清肌酐测定，年龄为65±11岁，中位随访时间为5.7年（范围0.1 - 10.2年）。女性的中位年估计肾小球滤过率斜率为-1.31 ml·min⁻¹·1.73 m⁻²，男性为-1.77 ml·min⁻¹·1.73 m⁻²（P < 0.001）。男性发生终末期肾病的可能性高于女性（22例男性 vs. 7例女性；P（对数秩检验）= 0.03）。在调整年龄、2型糖尿病诊断时间、糖化血红蛋白、收缩压和尿白蛋白：肌酐比值后，男性是估计肾小球滤过率急剧下降的独立危险因素[调整后的优势比 = 1.33（1.02 - 1.76），P = 0.04]。多变量线性混合效应模型显示男性和女性之间的估计肾小球滤过率轨迹存在显著差异（P < 0.001）。