Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
J Diabetes. 2020 Aug;12(8):583-593. doi: 10.1111/1753-0407.13034. Epub 2020 Mar 25.
The relationship between alcohol intake and end-stage kidney disease (ESKD) risk is controversial. Moreover, while evidence has shown that the relationship between alcohol and atherosclerosis may be modified by diabetes, whether this applies to ESKD is unknown.
We examined these associations in the Singapore Chinese Health Study, a prospective cohort of 63 257 adults aged 45 to 74 years. Information on alcohol intake, diet, lifestyle factors, and medical history was collected at recruitment. We identified 1217 ESKD cases via linkage with the Singapore Renal Registry after a mean follow-up of 17.5 years. Cox regression models were used to estimate hazard ratios (HRs) and 95% CI of ESKD.
Among the participants without diabetes at baseline, monthly to weekly drinking was associated with a decreased risk of ESKD (HR 0.69; 95% CI, 0.54-0.87) compared to nondrinkers. In contrast, this association was attenuated and not significant among those with diabetes (HR 0.82; 95% CI, 0.58-1.16; P = .19). Comparatively, alcohol intake of ≥2 drinks per day was significantly associated with an increased risk of ESKD compared to nondrinkers among those with diabetes (HR 2.00; 95% CI, 1.14-3.53) but not among those without diabetes (HR 0.91; 95% CI, 0.53-1.56; P = .01). The risk of ESKD among those with diabetes and who also consumed ≥2 drinks per day was increased by nearly 12-fold compared to nondrinkers without diabetes (HR 11.6; 95% CI, 6.73-19.9).
Low-dose drinking is associated with a reduced risk of ESKD among individuals without diabetes. However, joint exposure to heavy drinking and diabetes is associated with a substantially higher risk of ESKD.
饮酒与终末期肾病（ESKD）风险之间的关系存在争议。此外，虽然有证据表明酒精与动脉粥样硬化之间的关系可能受糖尿病影响，但这种关系是否适用于 ESKD 尚不清楚。
我们在新加坡华人健康研究中研究了这些关联，这是一项前瞻性队列研究，纳入了 63257 名年龄在 45 至 74 岁的成年人。在招募时收集了关于饮酒、饮食、生活方式因素和病史的信息。在平均随访 17.5 年后，通过与新加坡肾脏登记处的链接，我们确定了 1217 例 ESKD 病例。使用 Cox 回归模型估计 ESKD 的风险比（HR）和 95%置信区间（CI）。
在基线时没有糖尿病的参与者中，与不饮酒者相比，每月至每周饮酒与 ESKD 风险降低相关（HR 0.69；95%CI，0.54-0.87）。相比之下，在患有糖尿病的参与者中，这种关联减弱且不显著（HR 0.82；95%CI，0.58-1.16；P =.19）。相比之下，与不饮酒者相比，糖尿病患者每天饮酒≥2 杯与 ESKD 风险增加显著相关（HR 2.00；95%CI，1.14-3.53），但在无糖尿病患者中无此关联（HR 0.91；95%CI，0.53-1.56；P =.01）。与不饮酒的无糖尿病患者相比，患有糖尿病且每天饮酒≥2 杯的患者的 ESKD 风险增加了近 12 倍（HR 11.6；95%CI，6.73-19.9）。
低剂量饮酒与无糖尿病个体的 ESKD 风险降低相关。然而，大量饮酒和糖尿病的共同暴露与 ESKD 的风险显著增加有关。
