Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
International Master Program of Translational Medicine, National United University, Miaoli, Taiwan.
Environ Pollut. 2023 Aug 15;331(Pt 1):121883. doi: 10.1016/j.envpol.2023.121883. Epub 2023 May 24.
The impact of melamine exposure on kidney outcomes in type 2 diabetes mellitus (T2D) patients remains unclear. In this prospective cohort study, 561 T2D patients during October 2016 and June 2020 were enrolled and followed until December 2021. Baseline one-spot urinary corrected melamine levels were measured by LC-MS/MS. Average daily intake (ADI) of melamine represented environmental melamine exposure in daily life, and was estimated using urinary corrected melamine level by creatinine excretion (CE)-based model. Primary kidney outcomes were defined as doubling of serum creatinine levels or end stage kidney disease (ESKD), and secondary kidney outcomes included rapid decline in kidney function as estimated glomerular filtration rate (eGFR) decline >5 ml/min/1.73 m/year. Baseline median urinary corrected melamine levels and estimated DI of melamine were 0.8 μg/mmol and 0.3 μg/kg/day in 561 T2D patients. During 3.7 years of follow-up, urinary corrected melamine level was positively correlated with reaching composite outcomes of either doubling of serum creation levels or ESKD and rapid decline in kidney function. Those with the highest quartile of urinary corrected melamine had 2.96-fold risk of composite outcomes of either doubling of serum creation levels or ESKD and 2.47-fold risk of eGFR decline >5 ml/min/1.73 m/year. Estimated ADI of melamine also had significant correlation with adverse kidney outcomes. Furthermore, the positive relationship between melamine exposure and rapid decline in kidney function was only found in T2D patients with male, baseline eGFR ≥60 ml/min/1.73 m or glycated hemoglobin ≤7%. In conclusion, melamine exposure is significantly associated with adverse kidney outcomes in T2D patients, especially in those with male, well sugar control or good baseline kidney function.
三聚氰胺暴露对 2 型糖尿病（T2D）患者的肾脏结局影响尚不清楚。在这项前瞻性队列研究中，纳入了 2016 年 10 月至 2020 年 6 月期间的 561 例 T2D 患者，并随访至 2021 年 12 月。采用 LC-MS/MS 检测 1 点尿校正后的三聚氰胺水平。平均每日摄入量（ADI）代表日常生活中的环境三聚氰胺暴露，根据基于尿肌酐排泄（CE）模型的尿校正三聚氰胺水平来估算。主要肾脏结局定义为血清肌酐水平翻倍或终末期肾病（ESKD），次要肾脏结局包括估计肾小球滤过率（eGFR）下降>5 ml/min/1.73 m/年的肾功能快速下降。561 例 T2D 患者的基线中位尿校正三聚氰胺水平和估计的三聚氰胺每日摄入量分别为 0.8 μg/mmol 和 0.3 μg/kg/天。在 3.7 年的随访期间，尿校正三聚氰胺水平与达到血清肌酐水平翻倍或 ESKD 及肾功能快速下降的复合结局呈正相关。尿校正三聚氰胺水平最高四分位数的患者发生血清肌酐水平翻倍或 ESKD 复合结局的风险增加 2.96 倍，eGFR 下降>5 ml/min/1.73 m/年的风险增加 2.47 倍。估计的三聚氰胺 ADI 也与不良肾脏结局有显著相关性。此外，三聚氰胺暴露与肾功能快速下降之间的正相关关系仅在男性、基线 eGFR≥60 ml/min/1.73 m 或糖化血红蛋白≤7%的 T2D 患者中存在。总之，三聚氰胺暴露与 T2D 患者的不良肾脏结局显著相关，尤其是在男性、血糖控制良好或基线肾功能良好的患者中。
