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2 型糖尿病合并高血压患者的白蛋白尿变化及其肾脏结局:一项真实世界观察性研究。

Changes in albuminuria and renal outcome in patients with type 2 diabetes and hypertension: a real-life observational study.

机构信息

Università degli Studi, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.

Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS), Barcelona.

出版信息

J Hypertens. 2018 Aug;36(8):1719-1728. doi: 10.1097/HJH.0000000000001749.

Abstract

OBJECTIVES

To assess the predictive role of changes in albuminuria on the loss of renal function under antihypertensive treatment in patients with type 2 diabetes (T2D).

METHODS

Clinical records from a total of 12 611 patients with hypertension and T2D, attending 100 antidiabetic centers in Italy, with normal estimated glomerular filtration rate (eGFR) at baseline and regular visits during a 4-year period were retrieved and analyzed. We assessed the association between changes in albuminuria status during a 1-year baseline period and time updated blood pressure (BP) and eGFR loss over the subsequent 4-year follow-up.

RESULTS

Mean age at baseline was 65 ± 9 years, known duration of diabetes11 ± 8 years, eGFR 85 ± 13 ml/min and BP 142 ± 17/81 ± 9 mmHg. Patients with persistent albuminuria showed the highest 4-year risk of eGFR loss more than 30% from baseline or onset of stage 3 chronic kidney disease (eGFR < 60 ml/min) as compared with those with persistent normal albuminuria (odds ratio 2.00, confidence interval 1.71-2.34; P < 0.001). Female sex, age, disease duration, BMI, low baseline eGFR, lipid profile, the number of antihypertensive drugs and variations in albuminuria status were associated with renal risk in the whole study population. Furthermore, lower time updated BP values and the use of renin-angiotensin-aldosterone-system-inhibitors were related to the occurrence of renal endpoints only in the subgroup of patients without albuminuria.

CONCLUSION

In patients with hypertension and T2D under real-life clinical conditions, changes in albuminuria parallel changes of renal risk. Albuminuria status could be a guide to optimize therapeutic strategy.

摘要

目的

评估蛋白尿变化在 2 型糖尿病(T2D)患者降压治疗下肾功能丧失中的预测作用。

方法

共检索和分析了来自意大利 100 个糖尿病中心的 12611 例高血压合并 T2D 患者的临床记录,这些患者基线时估算肾小球滤过率(eGFR)正常,且在 4 年期间定期就诊。我们评估了基线 1 年期间蛋白尿状态变化与随后 4 年随访期间更新的血压(BP)和 eGFR 损失之间的关联。

结果

基线时的平均年龄为 65±9 岁,糖尿病的已知病程为 11±8 年,eGFR 为 85±13ml/min,BP 为 142±17/81±9mmHg。与持续正常蛋白尿患者相比,持续蛋白尿患者的 4 年 eGFR 损失风险最高,超过基线或进入 3 期慢性肾脏病(eGFR<60ml/min)的 30%(比值比 2.00,95%置信区间 1.71-2.34;P<0.001)。女性、年龄、病程、BMI、基线 eGFR 较低、血脂谱、降压药物数量以及蛋白尿状态的变化与整个研究人群的肾脏风险相关。此外,在整个研究人群中,较低的更新 BP 值和使用肾素-血管紧张素-醛固酮系统抑制剂与肾脏终点的发生相关,仅在无蛋白尿患者亚组中相关。

结论

在现实临床条件下,高血压合并 T2D 患者的蛋白尿变化与肾脏风险变化平行。蛋白尿状态可以作为优化治疗策略的指导。

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