1 型糖尿病患者的白蛋白尿和非白蛋白尿性慢性肾脏病：与主要血管结局风险和全因死亡率的关联。
Albuminuric and non-albuminuric chronic kidney disease in type 1 diabetes: Association with major vascular outcomes risk and all-cause mortality.
机构信息
Diabetes and Metabolic Disease Section, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, 2 Via Paradisa, 56124 Pisa, Italy.
Diabetes and Metabolic Disease Section, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, 2 Via Paradisa, 56124 Pisa, Italy.
出版信息
J Diabetes Complications. 2018 Jun;32(6):550-557. doi: 10.1016/j.jdiacomp.2018.03.012. Epub 2018 Apr 3.
AIMS
Albuminuric and non-albuminuric phenotypes of chronic kidney disease (CKD) may have different cardiovascular risk and survival in type 1 diabetes (T1DM). Herein we estimated risk of major vascular outcomes by the EURODIAB PCS score and determined all-cause mortality rate in 774 T1DM according to CKD phenotypes.
METHODS
We evaluated the distribution of CKD phenotypes [no CKD, stages 1-2, non-albuminuric stage ≥3 (AlbCKD), albuminuric stage ≥3 (AlbCKD)], the EURODIAB risk score for major vascular outcomes [low- (LS), intermediate- (IS), and high- (HS) risk] and all-cause mortality over a follow-up of 8.25 ± 2.34 years.
RESULTS
Out of 774 subjects, 692 (89.4%) had no CKD, 53 (6.8%) CKD stages 1-2, 17 (2.2%) AlbCKD and 12 (1.6%) AlbCKD; 466 (60.2%) had LS, 205 (26.5%) IS and 103 (13.3%) HS. Distribution of HS was: no CKD, 9.1%; CKD stages 1-2, 34.0%; AlbCKD, 64.7%; AlbCKD, 91.7% (P < 0.0001). Mortality increased from no CKD, 3.0%; to stages 1-2, 15.1% (HR 4.504); AlbCKD, 29.4% (8.573); AlbCKD, 50.0% (20.683, P < 0.0001). Accounting for age and sex, HRs for mortality compared to no CKD were: CKD stages 1-2, 3.84 (P = 0.001); AlbCKD, 2.97 (P = 0.046); AlbCKD, 7.44 (P < 0.0001). Adjusting for sex and the EURODIAB score, HRs for mortality compared to no CKD were: CKD stages 1-2, 2.57 (P = 0.027); AlbCKD, 2.77 (P = 0.058); AlbCKD, 4.58 (P = 0.003).
CONCLUSIONS
In our T1DM cohort, one fifth of those with CKDs were non-albuminuric. This phenotype was associated with higher risk of major outcomes and similar rate of mortality as compared to CKD stages 1-2. The greatest risk and highest mortality occur in patients with AlbCKD.
目的
慢性肾脏病（CKD）的白蛋白尿和非白蛋白尿表型在 1 型糖尿病（T1DM）患者中可能具有不同的心血管风险和生存状况。在此，我们根据 CKD 表型评估了 EURODIAB PCS 评分的主要血管结局风险，并确定了 774 例 T1DM 患者的全因死亡率。
方法
我们评估了 CKD 表型[无 CKD、1-2 期、非白蛋白尿期≥3（AlbCKD）、白蛋白尿期≥3（AlbCKD）]、EURODIAB 主要血管结局风险评分[低风险（LS）、中风险（IS）和高风险（HS）]以及无 CKD 组、CKD 1-2 期组、AlbCKD 组和 AlbCKD 组的全因死亡率，随访时间为 8.25±2.34 年。
结果
在 774 例受试者中，692 例（89.4%）无 CKD，53 例（6.8%）CKD 1-2 期，17 例（2.2%）AlbCKD，12 例（1.6%）AlbCKD；466 例（60.2%）LS，205 例（26.5%）IS，103 例（13.3%）HS。HS 的分布为：无 CKD，9.1%；CKD 1-2 期，34.0%；AlbCKD，64.7%；AlbCKD，91.7%（P<0.0001）。死亡率从无 CKD 的 3.0%上升到 CKD 1-2 期的 15.1%（HR 4.504）；AlbCKD 期为 29.4%（8.573）；AlbCKD 期为 50.0%（20.683，P<0.0001）。与无 CKD 相比，在校正年龄和性别后，死亡率的 HR 分别为：CKD 1-2 期，3.84（P=0.001）；AlbCKD，2.97（P=0.046）；AlbCKD，7.44（P<0.0001）。在校正性别和 EURODIAB 评分后，与无 CKD 相比，死亡率的 HR 分别为：CKD 1-2 期，2.57（P=0.027）；AlbCKD，2.77（P=0.058）；AlbCKD，4.58（P=0.003）。
结论
在我们的 T1DM 队列中，五分之一的 CKD 患者为非白蛋白尿患者。与 CKD 1-2 期相比，该表型与主要结局风险增加和死亡率相似。在 AlbCKD 患者中，风险最高，死亡率最高。
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