Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Diabetes Metab J. 2021 Sep;45(5):684-697. doi: 10.4093/dmj.2020.0109. Epub 2021 Mar 16.
To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up.
Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors.
The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]).
We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.
本研究旨在调查伊朗成年糖尿病患者在超过 14 年的随访期间慢性肾脏病（CKD）的人群发病率及其潜在危险因素。
本研究应用两种不同的方程（慢性肾脏病流行病学协作组 [CKD-EPI] 和肾脏病饮食改良试验 [MDRD]）来计算估算肾小球滤过率（eGFR）。在总共 1374 名德黑兰成年糖尿病患者中，797 名和 680 名患者分别符合 CKD-EPI 和 MDRD 分析的条件。CKD 的定义为 eGFR 低于 60 mL/min/1.73 m2。多变量 Cox 比例风险模型用于估计所有潜在危险因素的风险比（HR）和 95%置信区间（CI）。
基于 CKD-EPI 和 MDRD 方程，CKD 的发病率（95%CI）为每 1000 人年 43.84（39.49 至 48.66）和 55.80（50.29 至 61.91）。年龄较大、心血管疾病史和较低的 eGFR 是两种方程中的显著危险因素。此外，在 CKD-EPI 中，使用降糖药物和高血压，以及在 MDRD 中，女性和空腹血糖≥10 mmol/L 也是独立的危险因素。关于判别指数，在全调整模型中，CKD-EPI 方程对预测 CKD 发病概率的 C 指数范围更高，而 MDRD 方程为 0.75（0.72 至 0.77）比 0.69（0.66 至 0.72）。
我们发现伊朗糖尿病人群中 CKD 的发病率超过 4%/年。与 MDRD 相比，建议 CKD-EPI 方程可以作为伊朗糖尿病人群中预测 CKD 发病风险的更好选择。
