Section of the Italian College of General Practitioners and Primary Care, S.Orsola-Malpighi Hospital, "Alma Mater" University, 9, Via Massarenti, 40138, Bologna, Italy.
Nephrology and Dialysis Unit, S. Maria della Scaletta Hospital, Imola, Bologna, Italy.
J Endocrinol Invest. 2019 Jul;42(7):787-796. doi: 10.1007/s40618-018-0983-0. Epub 2018 Nov 21.
Progressive chronic kidney disease represents a dreadful complication of type 2 diabetes mellitus (T2DM). We tested the pattern of use and the renal effects of old glucose-lowering drugs in T2DM patients cared for by Italian general practitioners (GPs).
Data of 2606 T2DM patients were extracted from the databases of GPs, who do not have access to the most recent glucose-lowering drugs in Italy. The rate of kidney function decline was calculated by CKD-EPI, based on two consecutive creatinine values.
Metformin was used in 55% of cases, either alone or with sulfonylureas/repaglinide, across the whole spectrum of CKD (from 66% in stage G1 to only 8% in G4). Sulfonylurea use peaked at 21-22% in stage G2-G3a, whereas repaglinide use significantly increased from 8% in G1 to 22% in G4. The median rate of CKD decline was - 1.64 mL/min/1.73 m per year; it was higher in G1 (- 3.22 per year) and progressively lower with CKD severity. 826 cases (31.7%) were classified as fast progressors (eGFR decline more negative than - 5 mL/min/1.73 m per year). The risk of fast progressing CKD was associated with increasing BMI, albuminuria, and sulfonylurea use, alone (OR, 1.47; 95% confidence interval, 1.16-1.85), or in association with metformin (OR, 1.40; 95% CI 1.04-1.88). No associations were demonstrated for metformin, cardiovascular and lipid lowering drug use.
In the setting of Italian family practice, sulfonylurea use is associated with progressive CKD in patients with T2DM. Metformin, at doses progressively reduced according to CKD stages, as recommended by guidelines, is not associated with fast progression.
进展性慢性肾脏病是 2 型糖尿病（T2DM）的一种可怕并发症。我们测试了意大利全科医生（GP）治疗的 T2DM 患者中使用旧的降糖药物的模式及其对肾脏的影响。
从 GP 的数据库中提取了 2606 名 T2DM 患者的数据，这些 GP 无法获得意大利最新的降糖药物。基于两次连续的肌酐值，CKD-EPI 计算了肾功能下降的速度。
在整个 CKD 范围内（从 G1 期的 66%到 G4 期的仅 8%），55%的患者单独或联合使用二甲双胍、磺酰脲类/瑞格列奈。磺酰脲类药物的使用率在 G2-G3a 期达到峰值，为 21-22%，而瑞格列奈的使用率从 G1 期的 8%显著增加到 G4 期的 22%。CKD 下降的中位数速度为-1.64 mL/min/1.73 m 每年；在 G1 期更快（每年-3.22 毫升/分钟/1.73 米），随着 CKD 严重程度的增加而逐渐降低。826 例（31.7%）被归类为快速进展者（eGFR 下降速度超过-5 毫升/分钟/1.73 米每年）。快速进展性 CKD 的风险与 BMI、白蛋白尿和磺酰脲类药物的使用有关，单独使用（OR，1.47；95%置信区间，1.16-1.85）或与二甲双胍联合使用（OR，1.40；95%CI 1.04-1.88）。未发现二甲双胍、心血管和降脂药物的使用与 CKD 快速进展相关。
在意大利家庭医疗实践中，磺酰脲类药物的使用与 T2DM 患者的进行性 CKD 相关。根据 CKD 分期，按照指南建议逐渐减少剂量的二甲双胍与快速进展无关。
