The George Institute for Global Health, UNSW Sydney, Sydney, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Diabetes Care. 2018 Jan;41(1):163-170. doi: 10.2337/dc17-1467. Epub 2017 Oct 27.
To assess the association between 2-year changes in urine albumin-to-creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes.
We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality; secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs).
Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26; 95% CI 1.13-1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93; 95% CI 0.83-1.04). However, after allowing for RtM, the effect of "real" decrease in UACR on the primary outcome was found to be significant (HR 0.84; 95% CI 0.75-0.94), whereas the estimated effect on an increase was unchanged.
Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
评估尿白蛋白与肌酐比值（UACR）在 2 年内的变化与 2 型糖尿病临床结局风险之间的关系。
我们分析了来自 ACTION IN DIABETES AND VASCULAR DISEASE: PRETERAX AND DIAMICRON MR CONTROLLED EVALUATION POST-TRIAL OBSERVATIONAL STUDY（ADVANCE-ON）研究 8766 名参与者的数据。UACR 的变化是通过两年间 UACR 的测量值计算得出的，分为三组：UACR 下降≥30%、轻微变化和 UACR 增加≥30%。通过分析从基线 UACR 分组开始变化，分为三分之一，我们再次分析了这些结果，考虑了回归均值（RtM）的影响。主要结局是主要大血管事件、肾脏事件和全因死亡率的复合结局；次要结局是这些组成部分。使用 Cox 回归模型估计风险比（HR）。
在中位随访 7.7 年期间，观察到 2191 例主要结局。在 2 年内 UACR 的升高独立预测主要结局的风险更高（UACR 增加≥30%与轻微变化相比的 HR：1.26；95%CI 1.13-1.41），而 UACR 的降低与风险降低无关（HR 0.93；95%CI 0.83-1.04）。然而，在考虑到 RtM 后，发现“真实”UACR 降低对主要结局的影响具有统计学意义（HR 0.84；95%CI 0.75-0.94），而对升高的估计影响则没有变化。
UACR 的变化预测了 2 型糖尿病主要临床结局和死亡率的变化，支持了随时间监测白蛋白尿变化的预后效用。
