Viazzi Francesca, Piscitelli Pamela, Giorda Carlo, Ceriello Antonio, Genovese Stefano, Russo Giuseppina, Guida Pietro, Fioretto Paola, De Cosmo Salvatore, Pontremoli Roberto
Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
PLoS One. 2017 Apr 19;12(4):e0176058. doi: 10.1371/journal.pone.0176058. eCollection 2017.
Metabolic Syndrome (Mets) and increased serum uric acid (SUA), are well known renal risk predictors and often coexist in patients with type 2 diabetes (T2D). Whether they independently contribute to the onset of CKD is at present unclear.
Within the AMD Annals database we identified patients with T2D and normal renal function and urine albumin excretion at baseline and regular follow-up visits during a 4-year period. Blood pressure, BMI, HDL, triglycerides, and SUA were available in 14,267 patients. The association between Mets and/or hyperuricemia (HU, top fifth gender specific quintile) and the occurrence of renal outcomes were evaluated.
At baseline 59% of patients (n = 8,408) showed Mets and 18% (n = 2,584) HU. Over the 4-year follow-up, 14% (n = 1,990) developed low eGFR (i.e. below 60 mL/min/1.73 m2), and 26% (n = 3,740) albuminuria. After adjustment for confounders, BP≥130/85, low HDL, triglycerides ≥150 and HU were independently related to the development of low eGFR (1.57, P<0.001; 1.13, P = 0.056; 1.18, P = 0.008; 1.26, P = 0.001) and of albuminuria (1.35, P<0.001; 1.18, P = 0.001; 1.15, P = 0.002; 1.24, P = 0.001), respectively. The incidence of low eGFR was higher in patients with HU independent of the presence or absence of Mets (21%, OR 1.30, p = 0.009 and 20%, 1.57, p<0.000 respectively), while albuminuria occurred more frequently in those with Mets and HU (32%, OR 1.25, p = 0.005) as compared to the reference group.
HU and Mets are independent predictors of CKD and its individual components in patients with T2D.
代谢综合征（Mets）和血清尿酸（SUA）升高是众所周知的肾脏风险预测指标，且在2型糖尿病（T2D）患者中常同时存在。目前尚不清楚它们是否独立促成慢性肾脏病（CKD）的发生。
在AMD Annals数据库中，我们识别出在4年期间基线及定期随访时肾功能和尿白蛋白排泄正常的T2D患者。14267例患者有血压、体重指数（BMI）、高密度脂蛋白（HDL）、甘油三酯和SUA的数据。评估了Mets和/或高尿酸血症（HU，特定性别最高五分位数）与肾脏结局发生之间的关联。
基线时，59%的患者（n = 8408）有Mets，18%（n = 2584）有HU。在4年随访期间，14%（n = 1990）出现估算肾小球滤过率（eGFR）降低（即低于60 mL/min/1.73 m²），26%（n = 3740）出现蛋白尿。在对混杂因素进行校正后，收缩压≥130/85、HDL降低、甘油三酯≥150和HU分别与eGFR降低（1.57，P<0.001；1.13，P = 0.056；1.18，P = 0.008；1.26，P = 0.001）和蛋白尿（1.35，P<0.001；1.18，P = 0.001；1.15，P = 0.002；1.24，P = 0.001）的发生独立相关。无论有无Mets，有HU的患者中eGFR降低的发生率更高（分别为21%，比值比[OR] 1.30，p = 0.009和20%，1.57，p<0.000），而与参照组相比，有Mets和HU的患者中蛋白尿更频繁出现（32%，OR 1.25，p = 0.005）。
HU和Mets是T2D患者CKD及其各个组分的独立预测指标。
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