Sawada Ryo, Hashimoto Yoshitaka, Senmaru Takafumi, Tanaka Muhei, Ushigome Emi, Yamazaki Masahiro, Fukui Michiaki
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Endocr Metab Immune Disord Drug Targets. 2018;18(6):590-595. doi: 10.2174/1871530318666180426112050.
Previous studies revealed the association between serum Nterminal pro-brain natriuretic peptide (NT-proBNP) level and chronic kidney diseases (CKD) in general population. However, little is known about the association between serum NT-proBNP level and incident CKD in patients with type 2 diabetes. Thus, we investigated the impact of serum NT-proBNP level on incident CKD in patients with type 2 diabetes.
We enrolled 211 type 2 diabetic patients without CKD in this cohort study. CKD was diagnosed as estimated glomerular filtration rate <60 ml/min/1.73 m2. We divided the patients into three groups according to the tertiles of serum NT-proBNP level. Univariates and multivariate hazard ratios (HRs) for the incident CKD were calculated by Cox regression analyses.
Over the median follow-up period of 7 years, 56 patients developed incident CKD. Log NTproBNP was positively associated with incident CKD (HR 3.70, 95%CI 1.72-8.18, p <0.001). Compared with the lowest level of serum NT-proBNP tertile (≤36 pg/mL), the highest level of serum NTproBNP tertile (≥84 pg/mL) showed increased risk of incident CKD after adjusting age, sex, body mass index, hemoglobin A1c, creatinine, smoking, usage of hypertension drug and urinary albumin excretion at baseline examination (adjusted HR2.37, 95% CI 1.09-5.48, p = 0.028).
Serum NT-proBNP level is an independent biomarker for incident CKD in patients with type 2 diabetes.
既往研究揭示了普通人群血清N末端脑钠肽前体（NT-proBNP）水平与慢性肾脏病（CKD）之间的关联。然而，关于2型糖尿病患者血清NT-proBNP水平与新发CKD之间的关联却知之甚少。因此，我们研究了血清NT-proBNP水平对2型糖尿病患者新发CKD的影响。
在这项队列研究中，我们纳入了211例无CKD的2型糖尿病患者。CKD被诊断为估算肾小球滤过率<60 ml/min/1.73 m²。我们根据血清NT-proBNP水平的三分位数将患者分为三组。通过Cox回归分析计算新发CKD的单变量和多变量风险比（HR）。
在7年的中位随访期内，56例患者发生了新发CKD。Log NTproBNP与新发CKD呈正相关（HR 3.70，95%CI 1.72 - 8.18，p<0.001）。与血清NT-proBNP三分位数最低水平组（≤36 pg/mL）相比，血清NT-proBNP三分位数最高水平组（≥84 pg/mL）在调整年龄、性别、体重指数、糖化血红蛋白、肌酐、吸烟、高血压药物使用情况及基线检查时的尿白蛋白排泄量后，新发CKD的风险增加（校正HR 2.37，95%CI 1.09 - 5.48，p = 0.028）。
血清NT-proBNP水平是2型糖尿病患者新发CKD的独立生物标志物。
