Yanagawa Tatsuo, Koyano Keiko, Azuma Koichiro
Department of Medicine, Nerima General Hospital, 1-24-1 Asahigaoka, Nerima-ku, Tokyo, 176-8530 Japan.
Institute of Healthcare Quality Improvement, Public Interest Incorporated Foundation Tokyo Healthcare Foundation, Tokyo, Japan.
Diabetol Int. 2021 Jan 2;12(3):268-276. doi: 10.1007/s13340-020-00483-1. eCollection 2021 Jul.
This study was aimed at retrospectively investigating some common clinical factors, including the serum level of magnesium (Mg), associated with progression and remission/regression of diabetic kidney disease (DKD).
The subjects were 690 Japanese patients with type 2 diabetes mellitus who were receiving treatment with oral antidiabetic drugs other than SGLT2 inhibitors. Routine clinical data were collected on the first and last day of the observation period. The prognosis of DKD is categorized into four stages according to the Kidney Disease Improving Global Outcomes classification. Progression was defined as transition from any of the lower three risk categories (LR, MIR, HR) at the start of the observation period, to the VHR stage/category at the end of the observation period. Remission/regression was defined as improvement of the risk category by at least one stage from the start to the end of the observation period. Factors associated with progression and regression/remission were investigated using Cox proportional hazards analysis. Furthermore, the factors associated with the annual decrease in eGFR of 5 ml/min/1.73 m or more were examined by logistic regression analysis. Factors associated with transition of urinary protein negative to trace or positive, or transition of negative or trace to positive, were investigated by Cox proportional hazard analysis.
The observation period was 2251 ± 1614 days. Age (Exp [B] = 1.10, 95% CI; 1.06-1.14; < 0.01; 1 year old), serum Mg (Exp [B] = 0.82, 95% CI; 0.71-0.95; < 0.01); 0.1 mg/dl), and serum HbA1c (Exp [B] = 1.03, 95% CI; 1.01-1.05; < 0.01: 0.1%) were associated with progression of DKD; on the other hand, serum ALT was associated with the likelihood of remission/regression of DKD (Exp [B] = 1.01, 95% CI; 1.002-1.018; < 0.05; 1 IU/L). The decline in eGFR was associated with higher HbA1c levels, hypomagnesemia, and lower ALT. The new appearance of trace or overt proteinuria was correlated with higher HbA1c levels, advancing age, hypomagnesemia and hypertriglycemia.
Our findings confirmed previous reports that advancing age and serum HbA1c levels were associated with an increased risk of progression of DKD. Lower serum Mg concentrations were also found to be associated with a high risk of progression of DKD, and interventional studies are needed to confirm a causal relationship. Elevated HbA1c levels and hypomagnesemia were common factors in the decline in eGFR and the appearance of trace or overt proteinuria. Lower serum ALT levels were associated with the decline in eGFR. Since serum ALT is known to decrease as the renal function deteriorates, serum ALT is considered to be a marker of renal function.
The online version contains supplementary material available at 10.1007/s13340-020-00483-1.
本研究旨在回顾性调查一些常见的临床因素，包括血清镁（Mg）水平，这些因素与糖尿病肾病（DKD）的进展和缓解/消退相关。
研究对象为690例接受除SGLT2抑制剂以外的口服抗糖尿病药物治疗的日本2型糖尿病患者。在观察期的第一天和最后一天收集常规临床数据。根据改善全球肾脏病预后组织（KDIGO）的分类，DKD的预后分为四个阶段。进展定义为观察期开始时处于较低的三个风险类别（低风险、中风险、高风险）中的任何一个，到观察期结束时转变为极高风险阶段/类别。缓解/消退定义为观察期开始到结束时风险类别至少改善一个阶段。使用Cox比例风险分析研究与进展和消退/缓解相关的因素。此外，通过逻辑回归分析检查与估算肾小球滤过率（eGFR）每年下降5 ml/min/1.73m²或更多相关的因素。通过Cox比例风险分析研究与尿蛋白从阴性转变为微量或阳性，或从阴性或微量转变为阳性相关的因素。
观察期为2251±1614天。年龄（Exp[B]=1.10，95%可信区间；1.06 - 1.14；P<0.01；1岁）、血清镁（Exp[B]=0.82，95%可信区间；0.71 - 0.95；P<0.01；0.1mg/dl）和血清糖化血红蛋白（HbA1c）（Exp[B]=1.03，95%可信区间；1.01 - 1.05；P<0.01：0.1%）与DKD的进展相关；另一方面，血清谷丙转氨酶（ALT）与DKD缓解/消退的可能性相关（Exp[B]=1.01，95%可信区间；1.002 - 1.018；P<0.05；1 IU/L）。eGFR的下降与较高的HbA1c水平、低镁血症和较低的ALT相关。微量或显性蛋白尿的新出现与较高的HbA1c水平、年龄增长、低镁血症和高甘油三酯血症相关。
我们的研究结果证实了先前的报道，即年龄增长和血清HbA1c水平与DKD进展风险增加相关。还发现较低的血清镁浓度与DKD进展的高风险相关，需要进行干预性研究来证实因果关系。HbA1c水平升高和低镁血症是eGFR下降以及微量或显性蛋白尿出现的常见因素。较低的血清ALT水平与eGFR下降相关。由于已知血清ALT会随着肾功能恶化而降低，血清ALT被认为是肾功能的一个标志物。
在线版本包含可在10.1007/s13340 - 020 - 00483 - 1获取的补充材料。
