Institue of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; China Medical University Hospital, Taichung, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Institute of Preventive Medicine, College of Public Health, National Taiwan; University, Taipei, Taiwan.
Kidney Int. 2017 Aug;92(2):388-396. doi: 10.1016/j.kint.2017.01.030. Epub 2017 Jun 1.
This study aimed to identify the excess risks associated with diabetic patients with early kidney involvement (early diabetic kidney disease). The mortality risks of early diabetic kidney disease, defined as diabetes in early stages 1-3 chronic kidney disease (CKD), were assessed from a cohort of 512,700 adults in Taiwan participating in a health surveillance program from 1994-2008. Three related groups were identified and compared: diabetes without CKD, early diabetic kidney disease, and early CKD without diabetes. Deaths were ascertained through the National Death Registry. One-third of diabetics had early kidney disease, and approximately two-thirds of patients were classified with early CKD due to proteinuria. Patients with early diabetic kidney disease had more lifestyle risks such as inactivity or obesity, which characteristically amplified excess mortality by up to five times. The three-fold increase in all-cause mortality (hazard ratio 3.16) and a 16-year loss in life expectancy made early diabetic kidney disease a serious and yet often overlooked disease, with most patients unaware of their kidney involvement. Mortality for early diabetic kidney disease was nearly twice as high as that for early CKD (hazard ratio 2.01) or diabetes without CKD (hazard ratio 1.79). The 16-year life span loss is much worse than individually from early CKD (six years) or diabetes (ten years). Thus, identifying early proteinuria among diabetic patients and realizing the importance of reducing lifestyle risks like inactivity is a clinical challenge, but can save lives.
本研究旨在确定伴有早期肾脏损害（早期糖尿病肾病）的糖尿病患者的超额风险。从 1994 年至 2008 年参加健康监测计划的 512700 名台湾成年人中，评估了患有早期糖尿病肾病（定义为早期 1-3 期慢性肾脏病[CKD]的糖尿病）患者的死亡率风险。确定了三个相关组并进行了比较：无 CKD 的糖尿病、早期糖尿病肾病和无糖尿病的早期 CKD。通过国家死亡登记处确定死亡。三分之一的糖尿病患者患有早期肾病，大约三分之二的患者因蛋白尿而被归类为早期 CKD。患有早期糖尿病肾病的患者有更多的生活方式风险，如不活动或肥胖，这会使超额死亡率增加高达五倍。全因死亡率增加三倍（风险比 3.16）和 16 年的预期寿命损失使早期糖尿病肾病成为一种严重但经常被忽视的疾病，大多数患者都不知道自己的肾脏受累。早期糖尿病肾病的死亡率几乎是早期 CKD（风险比 2.01）或无 CKD 的糖尿病（风险比 1.79）的两倍。16 年的预期寿命损失比单独的早期 CKD（六年）或糖尿病（十年）还要严重得多。因此，在糖尿病患者中发现早期蛋白尿并认识到减少不活动等生活方式风险的重要性是一项临床挑战，但可以挽救生命。
