Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
Clin Exp Nephrol. 2023 May;27(5):465-472. doi: 10.1007/s10157-023-02328-y. Epub 2023 Feb 25.
It remains unclear whether urinary albumin changes can predict subsequent kidney disease progression in people with diabetes.
This retrospective cohort study included 4570 Japanese adults with type 2 diabetes (T2D). The exposure was changes in urinary albumin-to-creatinine ratio (UACR) over 3 years, categorized into three categories: ≤ - 30%, minor change, or ≥ 30%. During the exposure period, eGFR decline was also examined and categorized into two categories: < 30% or ≥ 30% decline. The primary outcome was the composite of eGFR halving or initiation of kidney replacement therapy (KRT). The secondary outcome was the initiation of KRT.
In the spline model, the hazard ratio for the primary outcome increased linearly on the log scale of UACR changes. When classified into six groups based on the categories of UACR changes and eGFR decline, people with a ≤ - 30% UACR change and < 30% eGFR decline had a 38% lower incidence of the outcome compared to those with a minor UACR change and < 30% eGFR decline. Meanwhile, the risk in those with a ≤ - 30% UACR change and ≥ 30% eGFR decline was 2.89 times. People with a ≥ 30% UACR change had the higher risk, regardless of whether a ≥ 30% eGFR decline occurred. Similar results were obtained in the secondary outcome.
UACR changes can be a useful surrogate for kidney disease progression in people with T2D. However, when setting a decrease in UACR as the surrogate, it may be necessary to simultaneously evaluate kidney function decline.
目前尚不清楚糖尿病患者的尿白蛋白变化是否可以预测随后的肾脏疾病进展。
本回顾性队列研究纳入了 4570 名日本 2 型糖尿病（T2D）患者。暴露因素为 3 年内尿白蛋白与肌酐比值（UACR）的变化，分为三类：≤-30%、轻微变化或≥30%。在暴露期间，还检查了 eGFR 下降情况，并分为两类：<30%或≥30%下降。主要结局是 eGFR 减半或开始肾脏替代治疗（KRT）的复合结局。次要结局是开始 KRT。
在样条模型中，UACR 变化的对数标度上，主要结局的风险比呈线性增加。根据 UACR 变化和 eGFR 下降的类别将人群分为六组，与 UACR 变化较小且 eGFR 下降<30%的人群相比，UACR 变化≤-30%且 eGFR 下降<30%的人群的结局发生率降低了 38%。同时，UACR 变化≤-30%且 eGFR 下降≥30%的风险是 2.89 倍。无论是否发生 eGFR 下降≥30%，UACR 变化≥30%的人群发生风险更高。次要结局也得到了类似的结果。
UACR 变化可作为 T2D 患者肾脏疾病进展的有用替代指标。然而，在将 UACR 下降作为替代指标时，可能需要同时评估肾功能下降情况。
