Health Care Center, Kitasato University, Kanagawa, Japan.
Department of Laboratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
J Diabetes Complications. 2022 Jan;36(1):108080. doi: 10.1016/j.jdiacomp.2021.108080. Epub 2021 Oct 29.
A high urinary albumin excretion (UAE) and low glomerular filtration rate (GFR) are risk factors for progressive renal function loss in type 2 diabetic patients. In addition, diabetic retinopathy (DR) is also a risk factor for progressive renal function decline in microalbuminuric type 2 diabetic patients. We aimed to elucidate the factors, including DR, associated with a more severe situation of diabetic nephropathy, i.e., hemodialysis (HD) induction in normo- and microalbuminuric type 2 diabetic patients without renal dysfunction.
Normo- and microalbuminuric type 2 diabetic patients with normal renal function whose GFRs had been measured by iohexol injection in 1995-1997 and had been followed for over 5 years were analyzed (n = 199). HbA1c levels was divided into HbA1c ≥ 7.0 (n = 146) and <7.0 (n = 53) groups. The UAE levels were classified as normoalbuminuria (NA, n = 114) and microalbuminuria (MA, n = 85). Seventy-two patients had DR, and 96 had hypertension. Patients were followed up for 15.7 ± 6.0 years and frequency of and duration to the HD induction were evaluated.
During the study period, 8 patients received HD induction. There were no remarkable differences in the rates of HD induction between patients with and without HbA1c ≥7.0, microalbuminuria, DR or hypertension. A Kaplan-Meier analysis revealed that HbA1c ≥7.0 (p = 0.037) and DR (p = 0.037) were associated with a significantly higher risk of HD induction than HbA1c <7.0 and no DR, respectively while albuminuria grade and hypertension were not associated with the risk of HD induction. There was significant negative correlation between HbA1c and annual decline rate of eGFR and annual decline rate of eGFR in the patients with prepro-proliferative DR (PDR) was significantly higher than that in the patients without DR. In the multivariate analysis, HbA1c and PDR showed significant relationships with the annual decline rate of eGFR.
It was reasonable that poorer glycemic control affected HD induction for 16 years follow-up. However, DR, especially PDR, should also be considered a substantial risk factor for HD induction although microalbuminuria and hypertension did not predict it at the early stage of diabetic nephropathy in type 2 diabetic patients with normal renal function.
高尿白蛋白排泄（UAE）和低肾小球滤过率（GFR）是 2 型糖尿病患者肾功能进行性丧失的危险因素。此外，糖尿病视网膜病变（DR）也是微量白蛋白尿 2 型糖尿病患者肾功能进行性下降的危险因素。我们旨在阐明与正常和微量白蛋白尿 2 型糖尿病患者肾功能正常的透析（HD）诱导更严重的糖尿病肾病情况相关的因素，包括 DR。这些患者的 GFR 已在 1995-1997 年通过碘海醇注射测量，且已随访超过 5 年（n=199）。根据 HbA1c 水平将患者分为 HbA1c≥7.0（n=146）和＜7.0（n=53）组。UAE 水平分为正常白蛋白尿（NA，n=114）和微量白蛋白尿（MA，n=85）。72 例患者有 DR，96 例患者有高血压。患者随访 15.7±6.0 年，评估 HD 诱导的频率和持续时间。
在研究期间，有 8 例患者接受了 HD 诱导。HbA1c≥7.0、微量白蛋白尿、DR 或高血压患者的 HD 诱导率无显著差异。Kaplan-Meier 分析显示，HbA1c≥7.0（p=0.037）和 DR（p=0.037）与 HbA1c＜7.0 且无 DR 相比，HD 诱导的风险显著更高，而白蛋白尿分级和高血压与 HD 诱导的风险无关。HbA1c 与 eGFR 年下降率呈显著负相关，且前驱增殖性 DR（PDR）患者的 eGFR 年下降率显著高于无 DR 患者。在多变量分析中，HbA1c 和 PDR 与 eGFR 年下降率显著相关。
在 16 年的随访中，血糖控制较差会影响 HD 诱导是合理的。然而，尽管在肾功能正常的 2 型糖尿病患者糖尿病肾病的早期阶段，微量白蛋白尿和高血压并不能预测，但 DR，特别是 PDR，也应被视为 HD 诱导的重要危险因素。
