aNephrology Section, Hanover Medical School, Hanover bClinic of Nephrology, Hypertension, Endocrinology and Diabetology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany cDepartment of Medicine, Erie County Medical Center, Buffalo, New York, USA dKCL Guy's Hospital, London, UK eDepartment of Nephrology and Hypertension, Leiden University Medical Center, Leiden, The Netherlands fDivision of Hypertension, Universidad Autonome, Madrid, Spain gClinic of Nephrology, University Hospital, Düsseldorf, Germany.
J Hypertens. 2017 Dec;35(12):2501-2509. doi: 10.1097/HJH.0000000000001491.
It is important to know which factors predict the development of microalbuminuria in patients with diabetes mellitus type II.
Data from the Randomized Olmesartan and Diabetes Microalbuminuria Prevention Study were used to identify predictors for the new onset of microalbuminuria. Furthermore, the interaction of baseline albuminuria and baseline estimated glomerular filtration rate (eGFR) and the effects of treatment with olmesartan were investigated.
A total of 4447 patients were randomized to receive 40-mg olmesartan or placebo for a median of 3.2 years. Baseline urinary albumin-creatinine ratio (UACR) was the most important predictor of microalbuminuria, followed by age, weight, glycosylated hemoglobin type A1C, blood glucose, total cholesterol, SBP number of antihypertensive drugs and heart rate. The development of microalbuminuria was not affected by hemodynamic factors. The incidence of microalbuminuria increased from the lower to the higher UACR tertile at all baseline eGFR tertiles. The effects of olmesartan on prevention of new onset microalbuminuria were more obvious in those with the highest baseline UACR at all baseline eGFR tertiles. The eGFR declined more significantly in the olmesartan group (from 85.0 to 80.1 ml/min per 1.73 m), whereas the decrease in the placebo group was smaller (from 84.7 to 83.7 ml/min per 1.73 m). The highest rate of eGFR decline in the olmesartan group was in patients with the highest baseline eGFR (>95 ml/min per 1.73 m) at all baseline UACR tertiles. The transition from normoalbuminuria to microalbuminuria in the olmesartan treated patients was not accompanied by preservation of renal function.
Predictors of new onset microalbuminuria are the classical cardiovascular risk factors. Microalbuminuria development was associated with baseline UACR but not baseline eGFR, whereas eGFR decrease after introduction of olmesartan was dependent on baseline eGFR but not on baseline UACR. The effects of olmesartan on microalbuminuria development and on eGFR decrease are probably mediated by different mechanisms.Clinical Trials.gov number, NCT00185159.
了解哪些因素可预测 2 型糖尿病患者微量白蛋白尿的发生。
本研究使用随机奥美沙坦和糖尿病微量白蛋白尿预防研究的数据，以确定新发生微量白蛋白尿的预测因素。此外，还研究了基线白蛋白尿和基线估算肾小球滤过率（eGFR）的相互作用以及奥美沙坦治疗的影响。
共有 4447 例患者被随机分配接受 40mg 奥美沙坦或安慰剂治疗，中位时间为 3.2 年。基线尿白蛋白肌酐比（UACR）是微量白蛋白尿最重要的预测因素，其次是年龄、体重、糖化血红蛋白 A1C、血糖、总胆固醇、SBP 降压药数量和心率。微量白蛋白尿的发生不受血流动力学因素的影响。在所有基线 eGFR 三分位中，微量白蛋白尿的发生率随着 UACR 三分位从低到高而增加。在所有基线 eGFR 三分位中，奥美沙坦对预防新发生微量白蛋白尿的作用在基线 UACR 最高的患者中更为明显。奥美沙坦组 eGFR 下降更明显（从 85.0 降至 80.1ml/min/1.73m），而安慰剂组下降较小（从 84.7 降至 83.7ml/min/1.73m）。奥美沙坦组 eGFR 下降幅度最大的是所有基线 UACR 三分位中基线 eGFR 最高（>95ml/min/1.73m）的患者。奥美沙坦治疗患者从正常白蛋白尿转为微量白蛋白尿时，肾功能并未得到保留。
新发生微量白蛋白尿的预测因素是经典的心血管危险因素。微量白蛋白尿的发生与基线 UACR 相关，但与基线 eGFR 无关，而奥美沙坦引入后 eGFR 的下降与基线 eGFR 相关，而与基线 UACR 无关。奥美沙坦对微量白蛋白尿发展和 eGFR 下降的影响可能通过不同的机制介导。临床试验注册号，NCT00185159。
