Department of Internal Medicine, Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong-si, Korea.
Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
Sci Rep. 2023 Jan 6;13(1):295. doi: 10.1038/s41598-022-23352-0.
Diabetes mellitus (DM) is a well-known risk factor for mortality, and the risk is exacerbated by coexisting diabetic kidney disease (DKD). We aimed to explore the impact of DM on each cause of mortality according to kidney function and the presence of albuminuria. Data on subjects with DM were extracted from the Nationwide Health Insurance Database of South Korea between 2009 and 2012. Subjects were divided by eGFR and albuminuria into five groups. To evaluate the risk of diabetes, we used the Cox proportional hazards model. A total of 2,614,662 patients were enrolled in this study. Most causes of death showed a higher incidence in an advanced stage of DKD. In addition to all-cause mortality and cardiovascular death, the risk of death from neoplasms and diseases of the endocrine, respiratory, and digestive systems is increased by albuminuria. The synergistic effect of a reduced eGFR and the presence of albuminuria was prominent in death from circulatory diseases, and endocrine and metabolic diseases. The risk for mortality was different according to the stage of DKD. Even in patients with a favorable eGFR, the presence of albuminuria significantly increased the risk for mortality, especially that due to cardiovascular causes.
糖尿病（DM）是众所周知的死亡风险因素，而并存的糖尿病肾病（DKD）会使风险加剧。我们旨在根据肾功能和白蛋白尿的存在，探讨 DM 对每种死亡原因的影响。2009 年至 2012 年，从韩国国家健康保险数据库中提取了有 DM 病史的受试者的数据。根据 eGFR 和白蛋白尿将受试者分为五组。为了评估糖尿病的风险，我们使用了 Cox 比例风险模型。共有 2614662 名患者纳入本研究。大多数死因在 DKD 的晚期表现出更高的发生率。除了全因死亡率和心血管死亡率外，白蛋白尿还增加了肿瘤和内分泌、呼吸和消化系统疾病的死亡风险。eGFR 降低和白蛋白尿的协同作用在循环系统疾病和内分泌代谢疾病的死亡中表现明显。死亡率因 DKD 分期而异。即使在 eGFR 良好的患者中，白蛋白尿的存在也显著增加了死亡率的风险，尤其是心血管原因导致的死亡率。
