Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan.
School of Medicine, University of Jordan, Amman, Jordan.
J Diabetes Complications. 2023 Jun;37(6):108478. doi: 10.1016/j.jdiacomp.2023.108478. Epub 2023 Apr 17.
Diabetic kidney disease (DKD) increases the risk of cardiovascular (CV) complications, kidney disease progression, and mortality. We aimed to determine the incidence and risk of these outcomes according to DKD phenotype among the Jordanian population.
A total of 1172 type 2 diabetes mellitus patients with estimated glomerular filtration rates (eGFRs) of >30 ml/min/1.73 m were followed-up from 2019 to 2022. At baseline, patients were classified according to the presence of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 ml/min/1.73 m) into four phenotypes: non-DKD (reference category), albuminuric DKD without decreased eGFR, non-albuminuric DKD with decreased eGFR, and albuminuric DKD with decreased eGFR.
Mean follow-up was 2.9 ± 0.4 years. Overall, 147 patients (12.5 %) experienced CV events, while 61 (5.2 %) demonstrated kidney disease progression (eGFR: <30 ml/min/1.73 m). The mortality rate was 4.0 %. Multivariable-adjusted risk for CV events and mortality was greatest for the albuminuric DKD with decreased eGFR group (hazard ratio [HR]: 1.45, 95 % confidence interval [CI]: 1.02-2.33 and HR: 6.36, 95 % CI: 2.98-13.59, respectively), with the risk increasing when adjusted for prior CV history (HR: 1.47, 95 % CI: 1.06-3.42 and HR: 6.70, 95 % CI: 2.70-16.60, respectively). Risk of a ≥40 % decline in eGFR was greatest for the albuminuric DKD with decreased eGFR group (HR: 3.45, 95 % CI: 1.74-6.85), followed by the albuminuric DKD without decreased eGFR group (HR: 1.6, 95 % CI: 1.06-2.75).
Thus, patients with albuminuric DKD and decreased eGFR were at greater risk for poor CV, renal, and mortality outcomes compared to other phenotypes.
糖尿病肾病（DKD）增加了心血管（CV）并发症、肾脏疾病进展和死亡的风险。我们旨在确定根据约旦人群的 DKD 表型，这些结果的发生率和风险。
共纳入了 1172 名估计肾小球滤过率（eGFR）>30ml/min/1.73m2 的 2 型糖尿病患者，随访时间从 2019 年至 2022 年。在基线时，根据白蛋白尿（>30mg/g 肌酐）和 eGFR 降低（<60ml/min/1.73m2）将患者分为以下四种表型：非 DKD（参考类别）、无 eGFR 降低的白蛋白尿性 DKD、有 eGFR 降低的非白蛋白尿性 DKD 和有 eGFR 降低的白蛋白尿性 DKD。
平均随访时间为 2.9±0.4 年。总体而言，147 名患者（12.5%）发生 CV 事件，61 名患者（5.2%）出现肾脏疾病进展（eGFR：<30ml/min/1.73m2）。死亡率为 4.0%。多变量调整后的 CV 事件和死亡率风险最高的是有 eGFR 降低的白蛋白尿性 DKD 组（风险比 [HR]：1.45，95%置信区间 [CI]：1.02-2.33 和 HR：6.36，95% CI：2.98-13.59，分别），当调整既往 CV 病史时风险增加（HR：1.47，95% CI：1.06-3.42 和 HR：6.70，95% CI：2.70-16.60，分别）。eGFR 下降≥40%的风险最高的是有 eGFR 降低的白蛋白尿性 DKD 组（HR：3.45，95% CI：1.74-6.85），其次是无 eGFR 降低的白蛋白尿性 DKD 组（HR：1.6，95% CI：1.06-2.75）。
因此，与其他表型相比，有白蛋白尿性 DKD 和 eGFR 降低的患者 CV、肾脏和死亡率结局的风险更高。
