Low Serena, Tai E Shyong, Yeoh Lee Ying, Liu Yan Lun, Liu Jian Jun, Tan Kristin Hui Xian, Fun Sharon, Su Chang, Zhang Xiao, Subramaniam Tavintharan, Sum Chee Fang, Lim Su Chi
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore.
J Diabetes Complications. 2016 Sep-Oct;30(7):1248-54. doi: 10.1016/j.jdiacomp.2016.05.020. Epub 2016 May 24.
To elucidate the natural history of chronic kidney disease(CKD), which is defined as estimated glomerular filtration rate(eGFR)<60ml/min/1.73m(2) and/or increase of urinary albumin-to-creatinine ratio (uACR)≥30mg/g), and to identify factors associated with its onset and progression.
Prospective cohort study on individuals with T2DM attending Diabetes Centre in a regional hospital in Singapore from 2002. There were 553 patients with no pre-existing CKD for "onset" analysis and 967 patients with pre-existing CKD for "progression" analysis. Multivariable logistic regression was performed to determine risk factors of the outcomes.
The mean follow-up period was 5.8years (4.5-7.1) and 5.3years (3.9-6.9) for the onset and progression cohorts respectively. About 45% of individuals developed CKD and 41% had progression. Among subjects with CKD onset, albuminuria-only occurred in 75% of them. Majority of the patients remained in the same CKD risk-category during follow-up. Progression and regression occurred across all CKD-categories. Transitions to adjacent risk-category were much more likely than transitions bypassing adjacent state. Risk factors for CKD onset included baseline albuminuria, eGFR, HbA1c variability, body mass index, triglycerides and age (all P<0.05). The predictors for CKD progression or rapid-progression included HbA1c variability, baseline albuminuria, systolic blood pressure, LDL-cholesterol, eGFR, HbA1c and ethnicity (all P<0.05).
Albuminuria was the first manifestation of CKD in most T2DM patients. Transition across CKD-category occurred bi-directionally, but evolved largely in a stepwise fashion. The onset and progression of CKD were predicted by multiple risk factors, some of which were modifiable.
阐明慢性肾脏病（CKD）的自然病史，慢性肾脏病定义为估算肾小球滤过率（eGFR）<60ml/（min·1.73m²）和/或尿白蛋白与肌酐比值（uACR）升高≥30mg/g，并确定与其发病和进展相关的因素。
对2002年起在新加坡一家地区医院糖尿病中心就诊的2型糖尿病患者进行前瞻性队列研究。有553例无CKD病史的患者用于“发病”分析，967例有CKD病史的患者用于“进展”分析。采用多变量逻辑回归确定结局的危险因素。
发病队列和进展队列的平均随访时间分别为5.8年（4.5 - 7.1年）和5.3年（3.9 - 6.9年）。约45%的个体发生了CKD，41%出现了病情进展。在发生CKD的受试者中，仅白蛋白尿的情况占75%。大多数患者在随访期间仍处于相同的CKD风险类别。所有CKD类别均出现了病情进展和病情逆转。向相邻风险类别的转变比跨越相邻状态的转变更有可能发生。CKD发病的危险因素包括基线白蛋白尿、eGFR、糖化血红蛋白（HbA1c）变异性、体重指数、甘油三酯和年龄（均P<0.05）。CKD进展或快速进展的预测因素包括HbA1c变异性、基线白蛋白尿、收缩压、低密度脂蛋白胆固醇、eGFR、HbA1c和种族（均P<0.05）。
白蛋白尿是大多数2型糖尿病患者CKD的首发表现。CKD类别之间的转变是双向的，但主要以逐步方式演变。CKD的发病和进展由多种危险因素预测，其中一些是可改变的。
