Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom.
Division of Computing Science and Mathematics, University of Stirling, Stirling, United Kingdom.
J Am Soc Nephrol. 2021 Jan;32(1):138-150. doi: 10.1681/ASN.2020030323. Epub 2020 Sep 18.
There are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population.
In this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline.
We followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD.
Patients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.
目前仅有少数观察性研究评估了 2 型糖尿病患者发生 AKI 的风险，而同时在该人群中研究 AKI 和 CKD 的研究则更少。这限制了与非糖尿病患者相比，人们对 2 型糖尿病患者中 AKI 和 CKD 之间相互作用的理解。
在这项针对伴有或不伴有 2 型糖尿病的参与者的回顾性队列研究中，我们使用电子医疗记录评估 AKI 的发生率，并采用各种统计方法来确定其与 CKD 状态和进一步的肾功能下降的关系。
我们对 16700 名参与者（9417 名患有 2 型糖尿病，7283 名对照组无糖尿病）进行了中位数为 8.2 年的随访。与对照组相比，患有糖尿病的参与者更有可能发生 AKI（分别为 48.6%和 17.2%），并且在随访期间发生了预先存在的 CKD 或 CKD（分别为 46.3%和 17.2%）。在没有 CKD 的情况下，糖尿病患者的 AKI 发生率是对照组的近五倍（121.5 比 24.6 每 1000 人年）。在患有 CKD 的参与者中，糖尿病患者的 AKI 发生率是对照组的两倍多（在 CKD 诊断日期后每 1000 人年分别为 384.8 和 180.0，在招募后发生 CKD 之前每 1000 人年分别为 109.3 和 47.4）。在发生 AKI 之前，与对照组相比，糖尿病患者的 eGFR 斜率下降更为陡峭。在发生 AKI 后，无糖尿病患者的 eGFR 斜率下降变得更加陡峭，但糖尿病和预先存在 CKD 的患者则不然。
与无糖尿病患者相比，患有糖尿病的患者发生 AKI 的风险显著更高，对于预先存在 CKD 的患者也是如此。
