糖尿病合并肾脏疾病患者的血糖变异性与慢性肾脏病进展：回顾性队列研究
Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study.
作者信息
Habte-Asres Hellena Hailu, Murrells Trevor, Nitsch Dorothea, Wheeler David C, Forbes Angus
机构信息
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
出版信息
Diabetes Res Clin Pract. 2022 Nov;193:110117. doi: 10.1016/j.diabres.2022.110117. Epub 2022 Oct 13.
AIM
To investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease.
METHODS
A cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis.
RESULTS
There were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD ± 9.2), and a mean baseline eGFR 40.7 (±10.7) ml/min/1.73 m. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95 %CI) for each variability score group, were as follows: 21-40, 1.38 (1.27-1.50); 41-60, 1.54 (1.41-1.68); 61-80, 1.61 (1.45-1.79); and 81-100, 1.42 (1.19-1.68), compared with the group (score 0-20) with least variability. The adjusted sHR for CV were as follows: 6.7-9.9, 1.29 (1.15-1.45); 10.0-13.9, 1.55 (1.39-1.74); 14.0-20.1, 1.79 (1.60-2.01) and ≥20.2, 2.10 (1.88-2.34) compared to reference group 0-6.6.
CONCLUSIONS
Glycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.
目的
研究糖尿病和慢性肾脏病患者血糖变异性与终末期肾病（ESKD）发生之间的关联。
方法
一项队列研究，使用来自临床实践研究数据链的英国电子基层医疗健康记录。采用变异性评分和糖化血红蛋白（HbA1c）的个体内变异系数（CV）评估血糖变异性。我们使用竞争风险回归分析计算发生ESKD的亚分布风险比（sHR）。
结果
共有37222名符合条件的参与者（45.5%为男性），平均年龄76.4岁（标准差±9.2），平均基线估算肾小球滤过率（eGFR）为40.7（±10.7）ml/min/1.73m²。随访期间有5086例ESKD事件。与变异性最小的组（评分0 - 20）相比，各变异性评分组的校正sHR（95%置信区间）如下：21 - 40，1.38（1.27 - 1.50）；41 - 60，1.54（1.41 - 1.68）；61 - 80，1.61（1.45 - 1.79）；81 - 100，1.42（1.19 - 1.68）。CV的校正sHR如下：与参考组0 - 6.6相比，6.7 - 9.9，1.29（1.15 - 1.45）；10.0 - 13.9，1.55（1.39 - 1.74）；14.0 - 20.1，1.79（1.60 - 2.01）；≥20.2，2.10（1.88 - 2.34）。
结论
血糖变异性与糖尿病和慢性肾脏病患者ESKD的发生密切相关。
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