Nephrology Center, Toranomon Hospital, Tokyo, Japan
Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.
BMJ Open Diabetes Res Care. 2021 Aug;9(1). doi: 10.1136/bmjdrc-2021-002241.
Data on the association between longitudinal trajectory patterns of albuminuria and subsequent end-stage kidney disease (ESKD) and all-cause mortality in diabetic kidney disease (DKD) are sparse.
Drawing on nationally representative data of 329 patients with biopsy-proven DKD and an estimated glomerular filtration rate above 30 mL/min/1.73 m at the time of biopsy, we used joint latent class mixed models to identify different 2-year trajectory patterns of urine albumin to creatinine ratio (UACR) and assessed subsequent rates of competing events: ESKD and all-cause death.
A total of three trajectory groups of UACR were identified: 'high-increasing' group (n=254; 77.2%), 'high-decreasing' group (n=24; 7.3%), and 'low-stable' group (n=51; 15.5%). The 'low-stable' group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): 'low-stable', 109 (50-138); 'high-decreasing', 906 (468-1740); 'high-increasing', 1380 (654-2502)), and had the least subsequent risk of ESKD and all-cause death among the groups. Although there were no differences in baseline characteristics between the 'high-decreasing' group and the 'high-increasing' group, the 'high-decreasing' group had better control over blood pressure, blood glucose, and total cholesterol levels during the first 2 years of follow-up, and the incidence rates of subsequent ESKD and all-cause death were lower in the 'high-decreasing' group compared with the 'high-increasing' group (incidence rate of ESKD (per 1000 person-years): 32.7 vs 77.4, p=0.014; incidence rate of all-cause death (per 1000 person-years): 0.0 vs 25.4, p=0.007).
Dynamic changes in albuminuria are associated with subsequent ESKD and all-cause mortality in DKD. Reduction in albuminuria by improving risk profile may decrease the risk of ESKD and all-cause death.
关于白蛋白尿纵向轨迹模式与糖尿病肾病（DKD）患者后续终末期肾病（ESKD）和全因死亡率之间的关系的数据很少。
利用全国代表性的 329 名经活检证实的 DKD 患者数据，以及活检时肾小球滤过率估计值大于 30ml/min/1.73m2，我们使用联合潜在类别混合模型来确定尿白蛋白与肌酐比值（UACR）的不同 2 年轨迹模式，并评估后续竞争事件的发生率：ESKD 和全因死亡。
共确定了 UACR 的三个轨迹组：“高升高”组（n=254；77.2%）、“高降低”组（n=24；7.3%）和“低稳定”组（n=51；15.5%）。“低稳定”组的风险状况最好，包括基线 UACR（中位数（IQR）UACR（mg/g 肌酐）：“低稳定”组 109（50-138）；“高降低”组 906（468-1740）；“高升高”组 1380（654-2502）），并且在这些组中，ESKD 和全因死亡的后续风险最低。尽管“高降低”组和“高升高”组在基线特征上没有差异，但在随访的前 2 年中，“高降低”组的血压、血糖和总胆固醇水平控制得更好，“高降低”组的 ESKD 和全因死亡发生率低于“高升高”组（ESKD 发生率（每 1000 人年）：32.7 比 77.4，p=0.014；全因死亡率（每 1000 人年）：0.0 比 25.4，p=0.007）。
白蛋白尿的动态变化与 DKD 患者的后续 ESKD 和全因死亡率有关。通过改善风险状况降低白蛋白尿可能会降低 ESKD 和全因死亡的风险。
