INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.
Diabetes Care. 2016 Jul;39(7):1259-66. doi: 10.2337/dc15-2607. Epub 2016 May 23.
The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event.
We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression.
In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort.
Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.
2 型糖尿病患者发生心血管（CV）事件前肾功能下降的模式尚不清楚。我们的目的是描述肾功能轨迹与 CV 事件发生之间的关系。
我们考虑了来自 SURDIAGENE（Survie，2 型糖尿病和遗传学）研究（发现队列）和 DIABHYCAR（非胰岛素依赖型糖尿病、高血压、微量白蛋白尿或蛋白尿、心血管事件和雷米普利）研究（复制队列）的 2 型糖尿病患者。使用线性混合效应模型确定主要心血管不良事件（MACE）或最后一次更新之前估计肾小球滤过率（eGFR）（慢性肾脏病流行病学合作研究 [CKD-EPI]）和血清肌酐（SCr）的全球模式，并通过简单线性回归计算每年的个体斜率。
在发现队列的 1040 名参与者中，建立了包括 6.3 年随访期间的 22227 个 SCr 的全球模式，结果显示 MACE 患者的 eGFR 每年下降和 SCr 每年增加，与无 MACE 患者相比，差异具有统计学意义（分别为-3.0 和-1.7 mL/min/1.73 m2/year 和+10.7 和+4.0 μmol/L/year；均 P<0.0001）。MACE 患者的中位年度个体斜率也明显更陡峭，eGFR 快速下降（变化小于-5 mL/min/1.73 m2/year）患者发生 MACE 的调整风险增加 4.11 倍（3.09-5.45）。考虑肾功能轨迹提供了重要的附加信息，有助于解释 SCr 和 eGFR 发生 MACE 的情况（分别为 PIDI<0.0001 和 P=0.0005）。这些结果在复制队列中得到了证实。
肾功能下降与 MACE 风险增加相关。肾功能下降模式超出了基线肾功能，是 CV 风险的一个独立因素。
