Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan
Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
Diabetes Care. 2020 May;43(5):1102-1110. doi: 10.2337/dc19-2049. Epub 2020 Mar 6.
Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes.
A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 mL/min/1.73 m) at baseline, participants were classified into the four DKD phenotypes-no-DKD, albuminuric DKD without reduced eGFR, nonalbuminuric DKD with reduced eGFR, and albuminuric DKD with reduced eGFR-to assess the risks of mortality, cardiovascular disease (CVD), and renal function decline.
During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher.
Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.
非白蛋白尿型糖尿病肾病（DKD）已成为 2 型糖尿病患者的主要表型。然而，其预后是否比其他 DKD 表型更差仍不清楚。
共有 2953 名日本 2 型糖尿病患者，肾小球滤过率（eGFR）≥30 mL/min/1.73 m2，于 2004 年参加一项观察性队列研究，随访至 2015 年。根据基线时蛋白尿（>30 mg/g 肌酐）和 eGFR 降低（<60 mL/min/1.73 m2），将患者分为四种 DKD 表型：无-DKD、白蛋白尿型 DKD 且 eGFR 不降低、非白蛋白尿型 DKD 且 eGFR 降低、白蛋白尿型 DKD 且 eGFR 降低，以评估死亡率、心血管疾病（CVD）和肾功能下降的风险。
在平均 9.7 年的随访期间，113 名患者死亡，263 名患者发生 CVD。在非白蛋白尿型 DKD 中，死亡或 CVD 的风险并不高于无-DKD（调整后的危险比 1.02 [95%CI 0.66, 1.60]），并且 eGFR 的年下降速度比其他 DKD 表型慢。无 CVD 既往史的非白蛋白尿型 DKD 的死亡或 CVD 风险与无 CVD 既往史的无-DKD 相似，而有 CVD 既往史的非白蛋白尿型 DKD 以及其他 DKD 表型的风险更高。
非白蛋白尿型 DKD 的死亡率、CVD 事件或肾功能下降风险并不高于其他 DKD 表型。在非白蛋白尿型 DKD 中，大血管并发症的存在可能是预后的主要决定因素，而不是肾脏表型。
