Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661, Cloppenburg, Germany.
Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany.
Cardiovasc Diabetol. 2019 Mar 16;18(1):33. doi: 10.1186/s12933-019-0837-x.
To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany.
Using combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR < 60 mL/min/1.73 m or eGFR ≥ 60 mL/min/1.73 m and albuminuria (≥ 30 mg/g). Median values of the most recent treatment year per patient are reported.
Among 343,675 patients with T2DM 171,930 had CKD. Patients with CKD had a median eGFR of 48.9 mL/min/1.73 m and 51.2% had a urinary albumin level ≥ 30 mg/g. They were older, had a longer diabetes duration and a higher proportion was females compared to patients without CKD (all p < 0.001). More than half of CKD patients (53.5%) were receiving long-acting insulin-based therapy versus around 39.1% of those without (p < 0.001). CKD patients also had a higher rate of hypertension (79.4% vs 72.0%; p < 0.001). The most common antihypertensive drugs among CKD patients were renin-angiotensin-aldosteron system inhibitors (angiotensin converting enzyme inhibitors 33.8%, angiotensin receptor blockers 14.2%) and diuretics (40.2%). CKD patients had a higher rate of dyslipidemia (88.4% vs 86.3%) with higher triglyceride levels (157.9 vs 151.0 mg/dL) and lower HDL-C levels (men: 40.0 vs 42.0 mg/dL; women: 46.4 vs 50.0 mg/dL) (all p < 0.001) and a higher rate of hyperkalemia (> 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p < 0.001).
The results illustrate the prevalence and morbidity burden associated with diabetic kidney disease in patients with T2DM in Germany. The data call for more attention to the presence of chronic kidney disease in patients with diabetes, should trigger intensified risk factor control up and beyond the control of blood glucose and HbA1c in these patients. They may also serve as a trigger for future investigations into this patient population asking for new treatment options to be developed.
评估德国患有或不患有慢性肾脏病（CKD）的 2 型糖尿病（T2DM）患者的特征。
使用合并的 DPV/DIVE 登记数据，分析纳入至少≥18 岁且有估算肾小球滤过率（eGFR）值的 T2DM 患者。CKD 的定义为 eGFR<60 mL/min/1.73 m 或 eGFR≥60 mL/min/1.73 m 且有白蛋白尿（≥30 mg/g）。报告每位患者最近治疗年度的中位数。
在 343675 名患有 T2DM 的患者中，有 171930 名患有 CKD。患有 CKD 的患者 eGFR 中位数为 48.9 mL/min/1.73 m，51.2% 的患者尿白蛋白水平≥30 mg/g。与无 CKD 的患者相比，他们年龄更大，糖尿病病程更长，且女性比例更高（均<0.001）。与无 CKD 的患者相比（分别为 39.1%和 53.5%），超过一半的 CKD 患者（53.5%）接受长效胰岛素为基础的治疗（<0.001）。CKD 患者的高血压发生率也更高（79.4% vs 72.0%；<0.001）。CKD 患者最常用的降压药物是肾素-血管紧张素-醛固酮系统抑制剂（血管紧张素转换酶抑制剂 33.8%，血管紧张素受体阻滞剂 14.2%）和利尿剂（40.2%）。CKD 患者的血脂异常发生率更高（88.4% vs 86.3%），甘油三酯水平更高（157.9 vs 151.0 mg/dL），高密度脂蛋白胆固醇水平更低（男性：40.0 vs 42.0 mg/dL；女性：46.4 vs 50.0 mg/dL）（均<0.001），高钾血症发生率更高（>5.5 mmol/L：3.7% vs. 1.0%）。合并症在 CKD 患者中更为常见（<0.001）。
结果说明了德国 T2DM 患者中糖尿病肾病的患病率和发病负担。这些数据表明，糖尿病患者中慢性肾脏病的存在应引起更多关注，应加强这些患者的危险因素控制，不仅要控制血糖和 HbA1c。这些数据也可能成为未来对该患者群体进行调查的触发因素，以寻求新的治疗选择。
