Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China.
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.
BMJ Open Diabetes Res Care. 2022 Dec;10(6). doi: 10.1136/bmjdrc-2022-003077.
Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared.
As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model.
The HRs for developing any CKD, CKD stages II-V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively.
Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
了解 2 型糖尿病（T2DM）患者慢性肾脏病（CKD）自然史中的种族差异，可能为解决住院和死亡率方面的差异提供临床策略。在新西兰奥克兰，比较了新西兰欧洲人（NZEs）、毛利人和太平洋岛民以及 T2DM 患者在 25 年内 CKD II-V 期的风险。
作为奥克兰的初级保健审计计划，糖尿病护理支持服务与国家登记数据库相连接。排除了现有的 CKD II-V 患者。为了平衡潜在的混杂因素，我们应用了锥形匹配方法。在毛利人和 NZE 之间以及在太平洋岛民和 NZE 之间分别建立了“准试验”匹配队列。通过加权 Cox 回归模型检查了 1994-2018 年期间任何和每个 CKD 阶段的风险的种族人群差异。
毛利人（n=2215）与 NZE（n=2028）相比，发展任何 CKD、CKD 阶段 II-V 的 HR 分别为 1.18（95%CI 0.99 至 1.41）、1.10（95%CI 0.91 至 1.32）、1.70（95%CI 1.19 至 2.43）、3.93（95%CI 2.16 至 7.14）和 3.74（95%CI 1.74 至 8.05）。与 NZE（n=2474）相比，太平洋岛民（n=3101）发展任何 CKD、CKD 阶段 II-V 的 HR 分别为 1.31（95%CI 1.09 至 1.57）、1.26（95%CI 1.05 至 1.52）、1.71（95%CI 1.14 至 2.57）、3.75（95%CI 1.40 至 10.05）和 4.96（95%CI 1.56 至 15.75）。
在新西兰患有 T2DM 的人群中，CKD 各阶段（特别是 CKD 阶段 V）的进展风险存在显著的种族差异。有必要对这些差异的机制研究，以及确定预测早期肾损伤的生物标志物的需求进行研究。
