Nagata Takanobu, Sobajima Hiroshi, Ohashi Norimi, Hirakawa Akihiro, Katsuno Takayuki, Yasuda Yoshinari, Matsuo Seiichi, Tsuboi Naotake, Maruyama Shoichi
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki, Japan.
PLoS One. 2016 May 2;11(5):e0152306. doi: 10.1371/journal.pone.0152306. eCollection 2016.
Data regarding the association between 24h urinary sodium and potassium excretion with kidney outcomes in patients with diabetes mellitus is currently scarce.
We conducted a single-center, retrospective cohort study in which 1230 patients with diabetes who had undergone a 24h urinary sodium and potassium excretion test were analyzed. Patients with incomplete urine collection were excluded based on 24h urinary creatinine excretion. Outcomes were the composite of a 30% decline in eGFR or death. Multivariate cox regression analysis was used to investigate the association between urinary sodium and potassium excretion and outcomes.
With a mean follow up period of 5.47 years, 130 patients reached the outcomes (30% decline in eGFR: 124, death: 6). Mean (SD) eGFR and 24h urinary sodium and potassium excretion at baseline were 78.6 (19.5) ml/min/1.73m2, 4.50 (1.64) g/day, and 2.14 (0.77) g/day. Compared with sodium excretion < 3.0 g/day, no significant change in risk of outcomes was observed with increased increments of 1.0 g/day. Compared with potassium excretion of < 1.5 g/day, 2.0-2.5 g/day, and 2.5-3.0 g/day were significantly associated with a lower risk of outcomes (hazard ratio [HR], 0.49 and 0.44; 95% confidence interval [CI], 0.28 to 0.84 and 0.22 to 0.87).
24h urinary sodium excretion was not significantly associated with a risk of 30% decline in eGFR or death in patients with diabetes. However, an increased risk of 30% decline in eGFR or death was significantly associated with 24h urinary potassium excretion < 1.5 g/day than with 2.0-2.5 g/day and 2.5-3.0 g/day.
目前关于24小时尿钠和钾排泄与糖尿病患者肾脏结局之间关联的数据稀缺。
我们进行了一项单中心回顾性队列研究，分析了1230例接受24小时尿钠和钾排泄测试的糖尿病患者。根据24小时尿肌酐排泄情况排除尿液收集不完整的患者。结局指标为估算肾小球滤过率（eGFR）下降30%或死亡的复合终点。采用多因素Cox回归分析来研究尿钠和钾排泄与结局之间的关联。
平均随访期为5.47年，130例患者达到了结局指标（eGFR下降30%：124例，死亡：6例）。基线时的平均（标准差）eGFR以及24小时尿钠和钾排泄量分别为78.6（19.5）ml/min/1.73m²、4.50（1.64）g/天和2.14（0.77）g/天。与钠排泄量<3.0 g/天相比，钠排泄量每天增加1.0 g时，结局风险未观察到显著变化。与钾排泄量<1.5 g/天相比，钾排泄量在2.0 - 2.5 g/天和2.5 - 3.0 g/天与较低的结局风险显著相关（风险比[HR]分别为0.49和0.44；95%置信区间[CI]分别为0.28至0.84和0.22至0.87）。
24小时尿钠排泄与糖尿病患者eGFR下降30%或死亡风险无显著关联。然而，与钾排泄量在2.0 - 2.5 g/天和2.5 - 3.0 g/天相比，24小时尿钾排泄量<1.5 g/天与eGFR下降30%或死亡风险增加显著相关。
