The George Institute for Global Health, University of New South Wales, Sydney, Australia
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Diabetes Care. 2020 May;43(5):982-990. doi: 10.2337/dc19-1803. Epub 2020 Mar 11.
To determine the incidence of and factors associated with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m in people with diabetes.
We identified people with diabetes in the EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45), a population-based cohort study (2006-2014) that linked the Sax Institute's 45 and Up Study cohort to community laboratory and administrative data in New South Wales, Australia. The study outcome was the first eGFR measurement <60 mL/min/1.73 m recorded during the follow-up period. Participants with eGFR < 60 mL/min/1.73 m at baseline were excluded. We used Poisson regression to estimate the incidence of eGFR <60 mL/min/1.73 m and multivariable Cox regression to examine factors associated with the study outcome.
Of 9,313 participants with diabetes, 2,106 (22.6%) developed incident eGFR <60 mL/min/1.73 m over a median follow-up time of 5.7 years (interquartile range, 3.0-5.9 years). The eGFR <60 mL/min/1.73 m incidence rate per 100 person-years was 6.0 (95% CI 5.7-6.3) overall, 1.5 (1.3-1.9) in participants aged 45-54 years, 3.7 (3.4-4.0) for 55-64 year olds, 7.6 (7.1-8.1) for 65-74 year olds, 15.0 (13.0-16.0) for 75-84 year olds, and 26.0 (22.0-32.0) for those aged 85 years and over. In a fully adjusted multivariable model incidence was independently associated with age (hazard ratio 1.23 per 5-year increase; 95% CI 1.19-1.26), geography (outer regional and remote versus major city: 1.36; 1.17-1.58), obesity (obese class III versus normal: 1.44; 1.16-1.80), and the presence of hypertension (1.52; 1.33-1.73), coronary heart disease (1.13; 1.02-1.24), cancer (1.30; 1.14-1.50), and depression/anxiety (1.14; 1.01-1.27).
In participants with diabetes, the incidence of an eGFR <60 mL/min/1.73 m was high. Older age, remoteness of residence, and the presence of various comorbid conditions were associated with higher incidence.
确定患有糖尿病的人群中估算肾小球滤过率（eGFR）<60mL/min/1.73m 的发生率和相关因素。
我们在 EXamining ouTcomEs in chroNic Disease in the 45 and Up Study（EXTEND45）中确定了患有糖尿病的人群，这是一项基于人群的队列研究（2006-2014 年），将 Sax 研究所的 45 岁及以上研究队列与澳大利亚新南威尔士州的社区实验室和行政数据相关联。研究结果是随访期间首次记录到的 eGFR<60mL/min/1.73m。基线时 eGFR<60mL/min/1.73m 的参与者被排除在外。我们使用泊松回归估计 eGFR<60mL/min/1.73m 的发生率，并使用多变量 Cox 回归检查与研究结果相关的因素。
在 9313 名患有糖尿病的参与者中，中位随访时间为 5.7 年（四分位距，3.0-5.9 年）期间，2106 名（22.6%）发生了 eGFR<60mL/min/1.73m。每 100 人年的 eGFR<60mL/min/1.73m 发生率总体为 6.0（95%CI5.7-6.3），45-54 岁参与者为 1.5（1.3-1.9），55-64 岁为 3.7（3.4-4.0），65-74 岁为 7.6（7.1-8.1），75-84 岁为 15.0（13.0-16.0），85 岁及以上为 26.0（22.0-32.0）。在完全调整的多变量模型中，发生率与年龄（每增加 5 岁的风险比为 1.23；95%CI1.19-1.26）、地理位置（远郊和偏远地区与主要城市：1.36；1.17-1.58）、肥胖（肥胖 III 级与正常：1.44；1.16-1.80）和高血压（1.52；1.33-1.73）、冠心病（1.13；1.02-1.24）、癌症（1.30；1.14-1.50）和抑郁/焦虑（1.14；1.01-1.27）独立相关。
在患有糖尿病的参与者中，eGFR<60mL/min/1.73m 的发生率较高。年龄较大、居住偏远以及存在各种合并症与更高的发生率相关。
