Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, 37126 Verona, Italy.
Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Diabetes Metab. 2018 Dec;44(6):473-481. doi: 10.1016/j.diabet.2018.08.007. Epub 2018 Sep 5.
We aimed to assess the association between decreasing estimated glomerular filtration rate (eGFR) or abnormal albuminuria and the risk of certain cardiac conduction defects in patients with type 2 diabetes mellitus (T2DM).
We examined a hospital-based sample of 923 patients with T2DM discharged from our Division of Endocrinology over the years 2007-2014. Standard electrocardiograms (ECGs) were performed in all patients. eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, whilst albuminuria was measured by an immuno-nephelometric method on morning spot urine samples.
A total of 253 (27.4%) patients had some type of cardiac conduction defects on standard ECGs (defined as at least one heart block among first-degree atrioventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block). Prevalence of patients with eGFR < 30 mL/min/1.73 m, eGFR 59-30 mL/min/1.73 m or abnormal albuminuria (i.e. urinary albumin-to-creatinine ratio ≥ 30 mg/g) were 7.0%, 29.4% and 41.3%, respectively. After adjustment for known cardiovascular risk factors, diabetes-related variables and potential confounders, there was a significant, graded association between decreasing eGFR values and risk of any cardiac conduction defects [adjusted-odds ratios of 2.05 (95% CI: 1.2-3.5), 2.85 (95% CI: 1.6-5.1) and 3.62 (95% CI: 1.6-8.1) for eGFR 89-60, eGFR 59-30 and eGFR < 30 mL/min/1.73 m, respectively]. Conversely, abnormal albuminuria was not independently associated with an increased risk of any conduction defects (adjusted-odds ratio: 1.09, 95% CI: 0.7-1.6).
Decreasing eGFR is independently associated with an increased risk of cardiac conduction defects in hospitalized patients with T2DM.
我们旨在评估估算肾小球滤过率（eGFR）下降或白蛋白尿异常与 2 型糖尿病（T2DM）患者某些心脏传导缺陷风险之间的关联。
我们检查了 2007 年至 2014 年期间我院内分泌科出院的 923 例 T2DM 患者的基于医院的样本。所有患者均进行标准心电图（ECG）检查。使用慢性肾脏病流行病学合作组（CKD-EPI）方程估算 eGFR，同时使用免疫比浊法测量晨尿样本中的白蛋白尿。
共有 253 名（27.4%）患者在标准 ECG 上存在某种类型的心脏传导缺陷（定义为一度房室传导阻滞、二度阻滞、三度阻滞、左束支阻滞、右束支阻滞、左前分支阻滞或左后分支阻滞中的至少一种心脏阻滞）。eGFR<30mL/min/1.73m、eGFR 59-30mL/min/1.73m 或白蛋白尿异常（即尿白蛋白与肌酐比值≥30mg/g）患者的患病率分别为 7.0%、29.4%和 41.3%。在调整了已知心血管危险因素、糖尿病相关变量和潜在混杂因素后，eGFR 值下降与任何心脏传导缺陷风险之间存在显著的、分级关联[eGFR 89-60、eGFR 59-30 和 eGFR<30mL/min/1.73m 的校正比值比（OR）分别为 2.05（95%CI：1.2-3.5）、2.85（95%CI：1.6-5.1）和 3.62（95%CI：1.6-8.1）]。相反，白蛋白尿异常与任何传导缺陷的风险增加无关（调整 OR：1.09，95%CI：0.7-1.6）。
在住院 T2DM 患者中，eGFR 下降与心脏传导缺陷风险增加独立相关。
