Kaiser Permanente Center for Health Research, Portland, OR, USA.
Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
J Diabetes Complications. 2018 Mar;32(3):291-297. doi: 10.1016/j.jdiacomp.2017.12.003. Epub 2017 Dec 18.
We evaluated the simultaneous effects of all clinically recognized categories of albuminuria and estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) and mortality METHODS: We conducted a longitudinal observational study of 16,678 type 2 diabetes (T2D) patients. From the first serum creatinine value from 2006 to 2012 and a urine-albumin creatinine ratio (UACR) recorded within 6months, we applied baseline Kidney Disease: Improving Global Outcomes (KDIGO) categories of eGFR and albuminuria. We followed patients for up to 11years to calculate adjusted incidence per 1000person-years (p-y) of first CVD hospitalization and all-cause mortality.
Over 98,069p-y of follow-up, CVD hospitalization risk was greater for each higher eGFR and albuminuria category. In eGFR category G2 (60-89mL/min/1.73m2), adjusted incidence per 1000p-y was 14.1 (95% CI 12.9-15.5), 19.8 (17.2-22.8), and 22.8 (17.4-30.0) for normoalbuminuria, microalbuminuria and macroalbuminuria, respectively. For eGFR category G3a (45-59), rates were 26.7 (22.3-32.0), 40.3 (32.2-50.5), and 44.1 (28.8-67.4), respectively. Adjusted risk of all-cause mortality followed a similar pattern.
Our data underscore the importance of including detailed eGFR and UACR values in assessing CVD risk. High albuminuria and low eGFR is a potent predictor of CVD and death.
我们评估了所有临床上公认的白蛋白尿和估算肾小球滤过率（eGFR）类别对心血管疾病（CVD）和死亡率的综合影响。
我们对 16678 例 2 型糖尿病（T2D）患者进行了一项纵向观察性研究。从 2006 年至 2012 年的首次血清肌酐值和 6 个月内记录的尿白蛋白肌酐比（UACR），我们应用了基线肾脏病：改善全球结局（KDIGO）的 eGFR 和白蛋白尿类别。我们对患者进行了长达 11 年的随访，以计算每 1000 人年（p-y）首次 CVD 住院和全因死亡率的校正发病率。
在超过 98069p-y 的随访中，每个更高的 eGFR 和白蛋白尿类别都与更大的 CVD 住院风险相关。在 eGFR 类别 G2（60-89mL/min/1.73m2）中，每 1000p-y 的校正发病率分别为 14.1（95%CI 12.9-15.5）、19.8（17.2-22.8）和 22.8（17.4-30.0），分别为正常白蛋白尿、微量白蛋白尿和大量白蛋白尿。对于 eGFR 类别 G3a（45-59），相应的发生率分别为 26.7（22.3-32.0）、40.3（32.2-50.5）和 44.1（28.8-67.4）。全因死亡率的调整风险也呈现出类似的模式。
我们的数据强调了在评估 CVD 风险时包括详细的 eGFR 和 UACR 值的重要性。高白蛋白尿和低 eGFR 是 CVD 和死亡的有力预测指标。
