Department of Medicine (Canadian Centre for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Medicine (Canadian Centre for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can J Diabetes. 2021 Jun;45(4):346-354.e1. doi: 10.1016/j.jcjd.2020.10.004. Epub 2020 Oct 14.
Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy.
This was a retrospective cohort study of CAKUT, by maternal diabetes status, from among all 1980‒2009 births in Saskatchewan First Nations (FN) and non-First Nations (non-FN) people. We determined frequencies, predictors and complications of CAKUT, as well as cumulative survival (to 2014) of affected persons until ESRD and death.
Of the 411,055 babies (204,167 mothers) in the Saskatchewan maternal-infant database, 2,540 had CAKUT (391 FN and 2,149 non-FN). Overall annual CAKUT incidence was 0.63% for non-FN and 0.57% for FN (p=0.082), but 5-year CAKUT incidence only increased among FN (0.40% in 1980‒1984 and 0.76% in 2005‒2009, p<0.0001) and was highest among offspring of FN mothers with pregestational diabetes (pre-G/DM) (0% before 1995, 2.51% in 2000‒2004 and 1.66% in 2005-2009). Pre-G/DM, but not gestational diabetes mellitus (GDM), was an independent predictor of CAKUT in non-FN (odds ratio, 1.79; 95% confidence interval, 1.20 to 2.69), and in FN interacting with maternal history of stillbirth (odds ratio, 7.90; 95% confidence interval, 1.14 to 54.6). ESRD was >100-fold more likely among offspring with CAKUT compared with all other offspring and was responsible for 40% of ESRD cases in young FN and non-FN people.
In Saskatchewan, pre-G/DM is an emerging cause of CAKUT, accounting for 40% of ESRD cases in FN/non-FN children and young adults. Because pre-G/DM‒related CAKUT is potentially preventable with optimal glycemic management, increased recognition of this serious complication is required.
由于先天性肾和尿路畸形（CAKUT）是年轻人终末期肾病（ESRD）的常见病因，我们探讨了 CAKUT 的流行病学以及妊娠糖尿病的作用。
这是一项针对萨斯喀彻温省第一民族（FN）和非第一民族（非 FN）人群中所有 1980-2009 年出生的按母体糖尿病状态分层的 CAKUT 回顾性队列研究。我们确定了 CAKUT 的频率、预测因素和并发症，以及受影响者直到 ESRD 和死亡的累积生存情况（截至 2014 年）。
在萨斯喀彻温省母婴数据库中，411055 名婴儿（204167 名母亲）中有 2540 名患有 CAKUT（391 名 FN 和 2149 名非 FN）。非 FN 的 CAKUT 年发生率为 0.63%，FN 为 0.57%（p=0.082），但 5 年 CAKUT 发生率仅在 FN 中增加（1980-1984 年为 0.40%，2005-2009 年为 0.76%，p<0.0001），且最高见于 FN 母亲孕前糖尿病（pre-G/DM）的后代（1995 年前为 0%，2000-2004 年为 2.51%，2005-2009 年为 1.66%）。Pre-G/DM 而非妊娠糖尿病（GDM）是非 FN 患者 CAKUT 的独立预测因素（比值比，1.79；95%置信区间，1.20 至 2.69），且与 FN 中死产史相互作用（比值比，7.90；95%置信区间，1.14 至 54.6）。与所有其他后代相比，患有 CAKUT 的后代发生 ESRD 的可能性高出 100 倍，在年轻的 FN 和非 FN 人群中，ESRD 占 40%。
在萨斯喀彻温省，Pre-G/DM 是 CAKUT 的一个新出现的病因，占 FN/非 FN 儿童和年轻成人 ESRD 病例的 40%。由于通过最佳血糖管理可以预防 Pre-G/DM 相关的 CAKUT，因此需要加强对这一严重并发症的认识。
