Lee Hye Won, Jo A Ra, Yi Dong Won, Kang Yang Ho, Son Seok Man
Department of Internal Medicine, Pusan National University School of Medicine and Diabetes Center, Pusan National University Yangsan Hospital, Yangsan, Korea.
Endocrinol Metab (Seoul). 2016 Dec;31(4):577-585. doi: 10.3803/EnM.2016.31.4.577.
Nonalbuminuric renal insufficiency is a unique category of diabetic kidney diseases. The objectives of the study were to evaluate prevalent rate of nonalbuminuric renal insufficiency and to investigate its relationship with previous cardiovascular disease (CVD) event in Korean patients with type 2 diabetes mellitus (T2DM).
Laboratory and clinical data of 1,067 subjects with T2DM were obtained and reviewed. Study subjects were allocated into four subgroups according to the CKD classification. Major CVD events were included with coronary, cerebrovascular, and peripheral vascular events.
Nonalbuminuric stage ≥3 CKD group, when compared with albuminuric stage ≥3 CKD group, had shorter diabetic duration, lower concentrations of glycated hemoglobin, high density lipoprotein cholesterol, and high-sensitivity C-reactive protein, lower prevalent rates of retinopathy and previous CVD, and higher rate of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Nonalbuminuric stage ≥3 CKD group showed a greater association with prior CVD events than no CKD group; however, albuminuric stage ≥3 CKD group made addition to increase prevalence of prior CVD events significantly when CKD categories were applied as covariates. Association of prior CVD events, when compared with normal estimated glomerular filtration rate (eGFR) and nonalbuminuria categories, became significant for declined eGFR, which was higher for eGFR of <30 mL/min/1.73 m², and albuminuria.
The results show that subjects with nonalbuminuric stage ≥3 CKD is significantly interrelated with occurrence of prior CVD events than those with normal eGFR with or without albuminuria. Comparing with normal eGFR and nonalbuminuria categories, the combination of increased degree of albuminuria and declined eGFR is becoming significant for the association of prior CVD events.
非蛋白尿性肾功能不全是糖尿病肾病的一种独特类型。本研究的目的是评估韩国2型糖尿病（T2DM）患者中非蛋白尿性肾功能不全的患病率，并调查其与既往心血管疾病（CVD）事件的关系。
获取并回顾了1067例T2DM患者的实验室和临床数据。根据慢性肾脏病（CKD）分类将研究对象分为四个亚组。主要CVD事件包括冠状动脉、脑血管和外周血管事件。
与蛋白尿性CKD≥3期组相比，非蛋白尿性CKD≥3期组糖尿病病程较短，糖化血红蛋白、高密度脂蛋白胆固醇和高敏C反应蛋白浓度较低，视网膜病变和既往CVD的患病率较低，使用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的治疗率较高。非蛋白尿性CKD≥3期组与既往CVD事件的关联比无CKD组更强；然而，当将CKD类别作为协变量时，蛋白尿性CKD≥3期组会显著增加既往CVD事件的患病率。与正常估计肾小球滤过率（eGFR）和无蛋白尿类别相比，既往CVD事件与eGFR下降的关联变得显著，对于eGFR<30 mL/min/1.73 m²和蛋白尿的情况，这种关联更强。
结果表明，非蛋白尿性CKD≥3期的患者与既往CVD事件的发生显著相关，比eGFR正常且有无蛋白尿的患者更密切。与正常eGFR和无蛋白尿类别相比，蛋白尿程度增加和eGFR下降的组合与既往CVD事件的关联变得显著。
