Department of Endocrinology & Metabolism, Government Medical College, Thiruvananthapuram, Kerala, India.
Department of Medicine, Government Medical College, Kottayam, Kerala, India.
Indian J Med Res. 2022 Oct-Nov;156(4&5):632-639. doi: 10.4103/ijmr.IJMR_2595_19.
BACKGROUND & OBJECTIVES:: A subset of diabetic individuals are known to develop progressive renal insufficiency without albuminuria, referred to as normoalbuminuric chronic kidney disease (NACKD). There is, however, a paucity of studies regarding this condition in India. So, this study, aimed to find the prevalence of normoalbuminuric renal dysfunction and its clinical associations in diabetic Indian population.
: Medical record search of patients with type 2 diabetes mellitus at a tertiary care centre was done. Based on the urinary albumin:creatinine ratio (>30 mg/g creatinine) and estimated glomerular filtration rate (e-GFR) (<60 ml/min/1.73m), individuals were classified as having, () no kidney disease (NKD), () chronic kidney disease (CKD), () albuminuria alone (ALB), () normoalbuminuric low e-GFR (NACKD) and () albuminuria with low e-GFR albuminuric CKD (ACKD). Furthermore, the clinical and biochemical parameters of these groups were also compared.
: Data from 3534 diabetes patients with a mean age of 53.8±10.9 yr and mean duration of diabetes of 10.3±7.5 yr were available for the analysis. NACKD constituted 39.1 per cent of the patients with reduced e-GFR, NACKD was found in 2.1 per cent and ACKD in 3.4 per cent of all diabetic patients. Compared to NKD patients, was found an independent association between NACKD and higher age, male sex, lower body weight and statin intake but not with glycated haemoglobin, fasting and postprandial plasma glucose. Patients with NACKD were found to be older than those with ACKD. Retinopathy was found to be more prevalent in the ACKD patients, whereas the rates of macrovascular complications were found to be similar between the groups. The prevalence of NACKD relative to ACKD decreased in CKD stages 3b, 4 and 5.
INTERPRETATION & CONCLUSIONS:: The results of this study suggest that NACKD constituted greater than one third of patients with diabetes and decreased e-GFR, which showed a strong association with age but not with duration or severity of hyperglycaemia or the presence of retinopathy. Both NACKD and ACKD showed similar associations with macrovascular disease.
已知一部分糖尿病患者会出现无白蛋白尿的进行性肾功能不全，即正常白蛋白尿性慢性肾脏病（NACKD）。然而，在印度，关于这种疾病的研究很少。因此，本研究旨在探讨印度糖尿病患者正常白蛋白尿性肾功能障碍的患病率及其临床相关性。
对一家三级保健中心的 2 型糖尿病患者的病历进行了检索。根据尿白蛋白与肌酐比值（>30mg/g 肌酐）和估算肾小球滤过率（e-GFR）(<60ml/min/1.73m)，将个体分为无肾脏疾病（NKD）、慢性肾脏病（CKD）、单纯白蛋白尿（ALB）、正常白蛋白尿性低 e-GFR（NACKD）和白蛋白尿合并低 e-GFR 白蛋白尿性 CKD（ACKD）。此外，还比较了这些组的临床和生化参数。
共分析了 3534 名糖尿病患者的数据，这些患者的平均年龄为 53.8±10.9 岁，糖尿病平均病程为 10.3±7.5 年。在 e-GFR 降低的患者中，NACKD 占 39.1%，NACKD 在所有糖尿病患者中占 2.1%，ACKD 占 3.4%。与 NKD 患者相比，NACKD 与年龄较大、男性、较低的体重和他汀类药物的摄入有关，但与糖化血红蛋白、空腹和餐后血糖无关。与 ACKD 患者相比，NACKD 患者年龄较大。ACKD 患者更易出现视网膜病变，而两组之间大血管并发症的发生率相似。在 CKD 3b、4 和 5 期，NACKD 相对于 ACKD 的患病率降低。
本研究结果表明，NACKD 占糖尿病伴 e-GFR 降低患者的三分之一以上，与年龄密切相关，但与糖尿病病程或血糖控制水平以及视网膜病变的发生无关。NACKD 和 ACKD 与大血管疾病的相关性相似。
