Loh Ping Tyug, Toh Matthias Paul Han Sim, Molina Joseph Antonio, Vathsala Anantharaman
Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Nephrology (Carlton). 2015 Mar;20(3):216-23. doi: 10.1111/nep.12379.
Diabetic kidney disease (DKD) incidence is rising in Singapore. While measures to prevent onset and early detection of diabetes as well as optimal diabetes and blood pressure control are important, early detection and treatment of DKD at primary care are crucial to ameliorate its course. This study aimed to evaluate the prevalence of DKD in a primary care cluster in Singapore and identify its risk factors in a multi-ethnic Asian population.
A total of 57,594 patients with type 2 diabetes mellitus (T2DM) followed-up at the National Healthcare Group Polyclinics with estimated glomerular filtration rate and at least two urine albumin/creatinine ratio (UACR) were stratified into DKD stages: normoalbuminuria (UACR <30 mg/g), microalbuminuria (MI, UACR 30-299 mg/g), macroalbuminuria (MA, ≥300 mg/g) and renal impairment (RI, estimated glomerular filtration rate eGFR <60 mL/min per 1.73 m(2)). Factors associated with DKD stages were evaluated.
Overall DKD prevalence (T2DM with MI, MA or RI) was high at 52.5%; 32.1% had MI, 5.3% had MA and 15.1% had RI. DKD prevalence within ethnic subpopulations was different: 52.2% of Chinese, 60.4% of Malays and 45.3% of Indians had DKD, respectively. Malays had a 1.42-fold higher DKD prevalence, while Indians had a 0.86-fold lower. Other independent risk factors were age, female gender, duration of diabetes and hypertension, HbA1c and body mass index.
The high prevalence of DKD and its interethnic differences suggest need for additional measures to optimize the care of T2DM at primary care to mitigate its progression.
新加坡糖尿病肾病（DKD）的发病率正在上升。虽然预防糖尿病的发病和早期检测以及优化糖尿病和血压控制的措施很重要，但在初级保健中早期检测和治疗DKD对于改善其病程至关重要。本研究旨在评估新加坡一个初级保健群组中DKD的患病率，并确定多民族亚洲人群中其危险因素。
共有57594例2型糖尿病（T2DM）患者在国家保健集团综合诊所接受随访，根据估算肾小球滤过率和至少两次尿白蛋白/肌酐比值（UACR）被分层为DKD各阶段：正常白蛋白尿（UACR<30mg/g）、微量白蛋白尿（MI，UACR 30 - 299mg/g）、大量白蛋白尿（MA，≥300mg/g）和肾功能损害（RI，估算肾小球滤过率eGFR<60mL/min/1.73m²）。评估与DKD各阶段相关的因素。
总体DKD患病率（伴有MI、MA或RI的T2DM）较高，为52.5%；32.1%有MI，5.3%有MA，15.1%有RI。不同种族亚人群中的DKD患病率有所不同：中国人中有52.2%、马来人中有60.4%、印度人中有45.3%患有DKD。马来人的DKD患病率高1.42倍，而印度人的患病率低0.86倍。其他独立危险因素包括年龄、女性性别、糖尿病和高血压病程、糖化血红蛋白和体重指数。
DKD的高患病率及其种族间差异表明，需要采取额外措施在初级保健中优化T2DM的护理，以减缓其进展。
