Schroijen Marielle A, de Mutsert Renée, Dekker Friedo W, de Vries Aiko P J, de Koning Eelco J P, Rabelink Ton J, Rosendaal Frits R, Dekkers Olaf M
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
Clin Kidney J. 2021 Apr 5;14(11):2383-2390. doi: 10.1093/ckj/sfab074. eCollection 2021 Nov.
Previous clinical studies have shown that various measures of glucose metabolism are associated with a risk of chronic kidney disease in different populations, but results were not consistent. In this study we assessed measures of glucose metabolism and their association with kidney function in a population-based study.
The Netherlands Epidemiology of Obesity study is a population-based cohort study of middle-aged men and women. We categorized the study population according to glycaemic levels into normoglycaemia (reference group), pre-diabetes mellitus (pre-DM), known DM and newly diagnosed DM. Outcome variables were serum creatinine, estimated glomerular filtration rate (eGFR), glomerular hyperfiltration (defined as an eGFR >90th percentile; >102 mL/min/1.73 m) and micro-albuminuria. We examined the association between measures of glucose metabolism [fasting glucose, haemoglobin A1c (HbA1c), fasting insulin, glucose area under the curve (AUC), insulin AUC, Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR), HOMA of β-cell function (HOMA-B) and disposition index] and measures of kidney function.
Of the total population ( = 6338), 55% of participants were classified as normoglycaemic (reference), 35% as pre-DM, 7% as DM and 4% as newly diagnosed DM. Compared with the reference group, diagnosed and newly diagnosed DMs were associated with a slightly higher trend in eGFR {+2.1 mL/min/1.73 m [95% confidence interval (CI) -0.2-4.4] and +2.7 mL/min/1.73 m [95% CI -0.3-5.7], respectively}. A 1% higher HbA1c was associated with increased odds of hyperfiltration [odds ratio (OR) 1.41 (95% CI 1.06-1.88)]. Higher levels of fasting plasma glucose, AUC glucose and HOMA-B were associated with hyperfiltration. Fasting insulin, AUC insulin and HOMA-IR were not associated with hyperfiltration. The OR of microalbuminuria was 1.21 (95% CI 1.04-1.42) per mmol/L higher fasting glucose concentrations.
Both fasting and post-prandial glucose and HOMA-B, but not measures of insulin resistance, were associated with glomerular hyperfiltration, while fasting glucose was also associated with microalbuminuria.
既往临床研究表明，不同人群中多种葡萄糖代谢指标与慢性肾脏病风险相关，但结果并不一致。在本基于人群的研究中，我们评估了葡萄糖代谢指标及其与肾功能的关联。
荷兰肥胖流行病学研究是一项基于人群的中年男性和女性队列研究。我们根据血糖水平将研究人群分为正常血糖（参照组）、糖尿病前期（糖尿病前期）、已知糖尿病和新诊断糖尿病。结局变量为血清肌酐、估计肾小球滤过率（eGFR）、肾小球高滤过（定义为eGFR>第90百分位数；>102 mL/min/1.73 m²）和微量白蛋白尿。我们研究了葡萄糖代谢指标[空腹血糖、糖化血红蛋白（HbA1c）、空腹胰岛素、葡萄糖曲线下面积（AUC）、胰岛素AUC、胰岛素抵抗稳态模型评估（HOMA-IR）、β细胞功能稳态模型评估（HOMA-B）和处置指数]与肾功能指标之间的关联。
在总人口（n = 6338）中，55%的参与者被分类为正常血糖（参照组），35%为糖尿病前期，7%为糖尿病，4%为新诊断糖尿病。与参照组相比，已诊断和新诊断糖尿病患者的eGFR呈略高的趋势{分别为+2.1 mL/min/1.73 m²[95%置信区间（CI）-0.2 - 4.4]和+2.7 mL/min/1.73 m²[95% CI -0.3 - 5.7]}。HbA1c每升高1%，高滤过几率增加[比值比（OR）1.41（95% CI 1.06 - 1.88）]。空腹血糖水平升高、葡萄糖AUC和HOMA-B与高滤过相关。空腹胰岛素、胰岛素AUC和HOMA-IR与高滤过无关。空腹血糖浓度每升高1 mmol/L，微量白蛋白尿的OR为1.21（95% CI 1.04 - 1.42）。
空腹和餐后血糖以及HOMA-B与肾小球高滤过相关，而胰岛素抵抗指标与之无关，同时空腹血糖也与微量白蛋白尿相关。
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