Clinical Research Unit, Khoo Teck Puat Hospital, Yishun, Singapore.
Department of Medicine, National Healthcare Group Polyclinics, Singapore.
Nephrol Dial Transplant. 2020 Jan 1;35(1):115-121. doi: 10.1093/ndt/gfy211.
The progression trajectory of renal filtration function has not been well characterized in patients with early-onset type 2 diabetes mellitus (T2DM) although albuminuria is often reported in this population. We aim to study the risk of progressive chronic kidney disease (CKD) in individuals with early-onset T2DM.
In total, 1189 T2DM participants were followed for 3.9 (interquartile range 3.2-4.7) years. Progressive CKD was defined as estimated glomerular filtration rate (eGFR) decline of ≥5 mL/min/1.73 m2 per year. Early-onset T2DM was defined as age at T2DM diagnosis between 18 and 30 years.
Compared with later-onset counterparts (N = 1032), participants with early-onset T2DM (N = 157) were more obese and had poorer glycaemic control at baseline. In the follow-up, 24.2% and 15.6% experienced progressive CKD in early-onset and later-onset participants, respectively (P = 0.007). Logistic regression suggested that participants with early-onset T2DM had 2.63-fold [95% confidence interval (CI) 1.46-4.75] higher risk of progressive CKD after accounting for multiple traditional risk factors. Furthermore, the excess risk of progressive CKD associated with early-onset T2DM mainly occurred in participants with preserved renal function [eGFR ≥60 mL/min/1.73 m2, odds ratio (OR) 2.85, 95% CI 1.50-5.42] and was more pronounced in those with diabetes duration <10 years (OR 3.67, 95% CI 1.51-8.90).
Individuals with early-onset T2DM have a higher risk of progressive CKD. The excess risk mainly exhibits in early stage of CKD and cannot be solely attributed to traditional risk factors and a longer diabetes duration.
尽管该人群常伴有白蛋白尿，但对于早期发病的 2 型糖尿病（T2DM）患者，其肾功能滤过功能的进展轨迹尚未得到充分描述。我们旨在研究早期发病的 T2DM 患者发生进展性慢性肾脏病（CKD）的风险。
共有 1189 例 T2DM 患者随访 3.9 年（四分位距 3.2-4.7 年）。进展性 CKD 定义为估算肾小球滤过率（eGFR）每年下降≥5 mL/min/1.73 m2。早期发病的 T2DM 定义为 T2DM 诊断时年龄在 18 至 30 岁之间。
与发病年龄较大的患者（N=1032）相比，早期发病的 T2DM 患者（N=157）在基线时更肥胖且血糖控制较差。在随访期间，早期发病和发病年龄较大的患者分别有 24.2%和 15.6%出现进展性 CKD（P=0.007）。经多因素校正后，logistic 回归显示，早期发病的 T2DM 患者发生进展性 CKD 的风险增加 2.63 倍（95%CI 1.46-4.75）。此外，与早期发病的 T2DM 相关的进展性 CKD 的超额风险主要发生在肾功能正常[eGFR≥60 mL/min/1.73 m2，比值比（OR）2.85，95%CI 1.50-5.42]的患者中，且在糖尿病病程<10 年的患者中更为显著（OR 3.67，95%CI 1.51-8.90）。
早期发病的 T2DM 患者发生进展性 CKD 的风险较高。该超额风险主要出现在 CKD 的早期阶段，不能仅归因于传统的危险因素和较长的糖尿病病程。
