Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, China.
Health Care Center of Kailuan Group, Tangshan, 063000, China.
J Transl Med. 2020 May 12;18(1):194. doi: 10.1186/s12967-020-02361-5.
The association between blood pressure change and kidney damage in patients with abnormal blood glucose remains unclear. The current study aimed to identify systolic blood pressure (SBP) trajectories among the prediabetic population and to determine their association with kidney damage after a long-term follow-up.
The incidence, development, and prognosis of diabetic kidney disease (INDEED) study is nested in the Kailuan cohort study with a focus on population with diabetes and prediabetes. We screened out people with prediabetes in 2006 and with more than three SBP records from 2006 to 2014 biennially. We used the latent mixture modeling to fit five groups of trajectories of SBP. In 2016, estimated glomerular filtration rate (eGFR), urinary albumin creatinine ratio (uACR), and urinary α1-microglobulin (α1MG), transferrin and α1-acid glycoprotein were measured, and the association between SBP trajectories and these markers was analyzed by linear regression and logistic regression models.
Totally, 1451 participants with prediabetes and without kidney damage were identified in 2006. Five heterogeneous SBP trajectories were detected based on the longitudinal data from 2006 to 2014, as low-stable group (n = 323), moderate-stable group (n = 726), moderate-increasing group (n = 176), moderate-decreasing group (n = 181), and high-stable group (n = 45). Linear regression analysis showed that the moderate and high SBP groups had lower eGFR, higher uACR, higher urinary α1MG, higher transferrin, and higher α1-acid glycoprotein than the low-stable group. Multivariable analysis attenuated the association but did not change the statistical significance.
Prediabetic patients with persistent high-level SBP trajectory or gradually increased SBP trajectory had severer kidney damage during follow-up.
血糖异常患者的血压变化与肾脏损害之间的关系尚不清楚。本研究旨在确定糖尿病前期人群的收缩压（SBP）轨迹，并在长期随访后确定其与肾脏损害的关系。
“糖尿病及前期的确切发病机制和转归研究（INDEED）”是凯洛恩队列研究的一个嵌套研究，主要关注糖尿病和糖尿病前期人群。我们在 2006 年筛选出糖尿病前期患者，并在 2006 年至 2014 年期间每两年从两次就诊中获取超过 3 次 SBP 记录。我们使用潜在混合模型拟合 SBP 的 5 组轨迹。2016 年，测量估算肾小球滤过率（eGFR）、尿白蛋白肌酐比（uACR）、尿α1-微球蛋白（α1MG）、转铁蛋白和α1-酸性糖蛋白，并通过线性回归和逻辑回归模型分析 SBP 轨迹与这些标志物的关系。
2006 年共筛选出 1451 例无肾脏损害的糖尿病前期患者。基于 2006 年至 2014 年的纵向数据，检测到 5 种不同的 SBP 轨迹，包括低稳定组（n=323）、中稳定组（n=726）、中升高组（n=176）、中降低组（n=181）和高稳定组（n=45）。线性回归分析显示，中、高 SBP 组的 eGFR 较低，uACR、尿α1MG、转铁蛋白和α1-酸性糖蛋白较高。多变量分析减弱了相关性，但没有改变统计学意义。
在随访期间，持续高水平 SBP 轨迹或逐渐升高的 SBP 轨迹的糖尿病前期患者肾脏损害更严重。
