美国2型糖尿病成年患者的慢性肾脏病：基于改善全球肾脏病预后组织（KDIGO）分期的患病率最新全国估计数
Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging.
作者信息
Bailey Robert A, Wang Yiting, Zhu Vivienne, Rupnow Marcia F T
机构信息
Janssen Scientific Affairs, LLC, 1000 Route 202 South, Raritan, NJ 08869, USA.
出版信息
BMC Res Notes. 2014 Jul 2;7:415. doi: 10.1186/1756-0500-7-415.
BACKGROUND
Kidney Disease Improving Global Outcomes (KDIGO) 2013 updated the classification and risk stratification of chronic kidney disease (CKD) to include both the level of renal function and urinary albumin excretion (UAE). The update subclassifies the previous category of moderate renal impairment. There is currently limited information on the prevalence of CKD based on this new classification in United States (US) adults with type 2 diabetes mellitus (T2DM). The objective of this study was to provide such estimates, for T2DM both overall and in those ≥ 65 years of age. We used the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2012 to identify participants with T2DM. Estimated glomerular filtration rate (eGFR) and UAE were calculated using laboratory results and data collected from the surveys, and categorized based on the KDIGO classification. Projections for the US T2DM population were based on NHANES sampling weights.
RESULTS
A total of 2915 adults diagnosed with T2DM were identified from NHANES, with 1466 being age ≥ 65 years. Prevalence of CKD based on either eGFR or UAE was 43.5% in the T2DM population overall, and 61.0% in those age ≥ 65 years. The prevalence of mildly decreased renal function or worse (eGFR < 60/ml/min/1.73 m2) was 22.0% overall and 43.1% in those age ≥ 65 years. Prevalence of more severe renal impairment (eGFR < 45 ml/min/1.73 m2) was 9.0% overall and 18.6% in those age ≥ 65 years. The prevalence of elevated UAE (> 30 mg/g) was 32.2% overall and 39.1% in those age ≥ 65 years. The most common comorbidities were hypertension, retinopathy, coronary heart disease, myocardial infarction, and congestive heart failure.
CONCLUSIONS
This study confirms the high prevalence of CKD in T2DM, impacting 43.5% of this population. Additionally, this study is among the first to report US prevalence estimates of CKD based on the new KDIGO CKD staging system.
背景
改善全球肾脏病预后组织（KDIGO）2013年更新了慢性肾脏病（CKD）的分类和风险分层，纳入了肾功能水平和尿白蛋白排泄量（UAE）。此次更新对之前中度肾功能损害类别进行了再分类。目前，基于这一新分类的美国2型糖尿病（T2DM）成年患者CKD患病率的相关信息有限。本研究的目的是提供总体T2DM患者以及年龄≥65岁患者的此类患病率估计值。我们利用1999 - 2012年连续的美国国家健康与营养检查调查（NHANES）来确定T2DM患者。根据实验室检查结果和调查收集的数据计算估计肾小球滤过率（eGFR）和UAE，并按照KDIGO分类进行归类。美国T2DM人群的预测数据基于NHANES抽样权重。
结果
从NHANES中总共确定了2915例诊断为T2DM的成年人，其中1466例年龄≥65岁。总体T2DM人群中，基于eGFR或UAE的CKD患病率为43.5%，年龄≥65岁人群中为61.0%。肾功能轻度降低或更严重（eGFR＜60/ml/min/1.73 m²）的总体患病率为22.0%，年龄≥65岁人群中为43.1%。更严重肾功能损害（eGFR＜45 ml/min/1.73 m²）的总体患病率为9.0%，年龄≥65岁人群中为18.6%。UAE升高（＞30 mg/g）的总体患病率为32.2%，年龄≥65岁人群中为39.1%。最常见的合并症为高血压、视网膜病变、冠心病、心肌梗死和充血性心力衰竭。
结论
本研究证实T2DM患者中CKD患病率很高，影响了该人群的43.5%。此外，本研究是首批基于KDIGO新的CKD分期系统报告美国CKD患病率估计值的研究之一。
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