Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Hyogo, Japan.
Research Institute for Nutrition Sciences, Mukogawa Women's University, Hyogo, Japan; Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan.
J Diabetes Res. 2016;2016:3295747. doi: 10.1155/2016/3295747. Epub 2016 Dec 20.
. Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population. However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function. . We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m and progression of CKD stages) over a median follow-up of 6.0 years. At baseline, 25 patients (15.4%) had CKD. Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration. Estimated GFR decreased from 75.8 ± 16.3 to 67.4 ± 18.2 mL/min/1.73 m ( < 0.01). Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages. Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1-14.226.7, and = 0.03) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04-1.21, and = 0.003) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count. Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.
. 亚临床动脉粥样硬化和长期血糖变异性已被报道可预测普通人群中慢性肾脏病（CKD）的发生。然而，这些关联尚未在肾功能正常的 2 型糖尿病患者中进行研究。. 我们前瞻性随访了 162 例 2 型糖尿病患者（平均年龄 62.3 岁；53.6%为男性），评估了通过 B 型超声测量的颈动脉内膜中层厚度（IMT）和随访间 HbA1c 变异性与 CKD 恶化（定义为估计肾小球滤过率[eGFR] < 60 mL/min/1.73 m 和 CKD 分期进展）的关系，中位随访时间为 6.0 年。基线时有 25 例（15.4%）患者患有 CKD。使用 Cox 比例风险回归模型识别 CKD 恶化的相关因素。eGFR 从 75.8±16.3 降至 67.4±18.2 mL/min/1.73 m（<0.01）。在 162 例患者中，32 例发生 CKD，8 例 CKD 分期进展。多变量 Cox 回归分析显示，颈动脉 IMT（HR：4.0，95%CI：1.1-14.2， = 0.03）和 HbA1c 变异系数（HR：1.12，95%：1.04-1.21， = 0.003）是 CKD 恶化的独立预测因素，与年龄、平均 HbA1c、尿白蛋白/肌酐比、基线 eGFR、尿酸和白细胞计数无关。. 亚临床动脉粥样硬化和长期血糖变异性可预测肾功能正常的 2 型糖尿病患者慢性肾脏病（定义为新发或 CKD 恶化）的恶化。
