Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sci Rep. 2020 Apr 22;10(1):6788. doi: 10.1038/s41598-020-63967-9.
Elderly patients with type 2 diabetes (T2DM) are more prone to developing diabetic kidney disease (DKD). Patients with DKD can develop albuminuria, and some studies have suggested an association between metabolic syndrome and albuminuria. The prevalence of both metabolic syndrome and albuminuria increases with age. We evaluated the association of these risk factors with worsening renal function and albuminuria progression in 460 T2DM patients with a mean age of 72 years. During the 5-year follow-up period, progression of albuminuria and worsening of renal function were observed in 97 (21.2%) and 23 (5.1%) patients, respectively. After adjusting for confounding factors, the group with metabolic syndrome had a higher multivariable-adjusted hazard ratio (HR) for worsening renal function (P = 0.038) and albuminuria progression (P = 0.039) than the group without metabolic syndrome. When patients were divided into four groups according to the presence of metabolic syndrome and/or albuminuria, the HR gradually increased. The group with both albuminuria and metabolic syndrome exhibited the highest cumulative incidence of worsening renal function (P = 0.003). When we redefined metabolic syndrome to exclude the blood pressure (BP) component, similar results were obtained. We concluded that the presence of metabolic syndrome independently predicts the progression of renal disease in elderly patients with T2DM. The use of both metabolic syndrome and albuminuria provides a better risk stratification model for DKD progression than albuminuria alone.
老年 2 型糖尿病（T2DM）患者更容易发生糖尿病肾病（DKD）。DKD 患者可出现白蛋白尿，一些研究表明代谢综合征与白蛋白尿之间存在关联。代谢综合征和白蛋白尿的患病率均随年龄增长而增加。我们评估了这些危险因素与 460 例平均年龄为 72 岁的 T2DM 患者肾功能恶化和白蛋白尿进展的关系。在 5 年的随访期间，分别有 97 例（21.2%）和 23 例（5.1%）患者出现白蛋白尿进展和肾功能恶化。在调整混杂因素后，患有代谢综合征的患者发生肾功能恶化的多变量校正风险比（HR）更高（P=0.038），白蛋白尿进展的 HR 也更高（P=0.039）。当根据是否存在代谢综合征和/或白蛋白尿将患者分为四组时，HR 逐渐升高。同时患有白蛋白尿和代谢综合征的患者发生肾功能恶化的累积发生率最高（P=0.003）。当我们将代谢综合征重新定义为排除血压（BP）成分时，也得到了类似的结果。我们得出结论，代谢综合征的存在独立预测老年 T2DM 患者肾脏疾病的进展。与单独使用白蛋白尿相比，同时使用代谢综合征和白蛋白尿为 DKD 进展提供了更好的风险分层模型。
