Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
Division of Pathology, West China Hospital of Sichuan University, Chengdu, China.
Ren Fail. 2021 Dec;43(1):477-487. doi: 10.1080/0886022X.2021.1893186.
Chronic kidney disease (CKD) and diabetes mellitus increase atherosclerotic cardiovascular diseases (ASCVD) risk. However, the association between renal outcome of diabetic kidney disease (DKD) and ASCVD risk is unclear.
This retrospective study enrolled 218 type 2 diabetic patients with biopsy-proven DKD, and without known cardiovascular diseases. Baseline characteristics were obtained and the 10-year ASCVD risk score was calculated using the Pooled Cohort Equation (PCE). Renal outcome was defined as progression to end-stage renal disease (ESRD). The association between ASCVD risk and renal function and outcome was analyzed with logistic regression and Cox analysis.
Among all patients, the median 10-year ASCVD risk score was 14.1%. The median of ASCVD risk score in CKD stage 1, 2, 3, and 4 was 10.9%, 12.3%, 16.5%, and 14.8%, respectively ( = 0.268). Compared with patients with lower ASCVD risk (＜14.1%), those with higher ASCVD risk had lower eGFR, higher systolic blood pressure, and more severe renal interstitial inflammation. High ASCVD risk (>14.1%) was an independent indicator of renal dysfunction in multivariable-adjusted logistic analysis (OR, 3.997; 95%CI, 1.385-11.530; = 0.010), though failed to be an independent risk factor for ESRD in patients with DKD in univariate and multivariate Cox analysis.
DKD patients even in CKD stage 1 had comparable ASCVD risk score to patients in CKD stage 2, 3, and 4. Higher ASCVD risk indicated severe renal insufficiency, while no prognostic value of ASVCD risk for renal outcome was observed, which implied macroangiopathy and microangiopathy in patients with DKD were related, but relatively independent.
慢性肾脏病（CKD）和糖尿病使动脉粥样硬化性心血管疾病（ASCVD）风险增加。然而，糖尿病肾病（DKD）患者的肾脏结局与 ASCVD 风险之间的关系尚不清楚。
本回顾性研究纳入了 218 名经活检证实的 2 型糖尿病伴 DKD 且无已知心血管疾病的患者。记录基线特征，并使用 Pooled Cohort Equation（PCE）计算 10 年 ASCVD 风险评分。将肾脏结局定义为进展为终末期肾病（ESRD）。采用逻辑回归和 Cox 分析探讨 ASCVD 风险与肾功能和结局的关系。
在所有患者中，中位 10 年 ASCVD 风险评分为 14.1%。CKD 1 期、2 期、3 期和 4 期患者的 ASCVD 风险评分中位数分别为 10.9%、12.3%、16.5%和 14.8%（ = 0.268）。与 ASCVD 风险较低（＜14.1%）的患者相比，ASCVD 风险较高的患者 eGFR 较低，收缩压较高，且肾间质炎症更严重。多变量调整后的逻辑回归分析显示，ASCVD 高风险（>14.1%）是多变量调整后肾功能不全的独立指标（OR，3.997；95%CI，1.385-11.530； = 0.010），但在单变量和多变量 Cox 分析中，DKD 患者 ASCVD 风险并非 ESRD 的独立危险因素。
即使在 CKD 1 期，DKD 患者的 ASCVD 风险评分也与 CKD 2、3 和 4 期患者相当。ASCVD 风险较高提示严重肾功能不全，而 ASCVD 风险对肾脏结局无预后价值，这表明 DKD 患者的大血管病变和微血管病变相关，但相对独立。
