青少年 2 型糖尿病患者 eGFR 轨迹与蛋白尿风险：来自 TODAY 队列研究的结果。
Trajectories of eGFR and risk of albuminuria in youth with type 2 diabetes: results from the TODAY cohort study.
机构信息
The Biostatistics Center, George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, MD, 20852, USA.
Baylor College of Medicine Children's Nutrition Research Center, Houston, TX, USA.
出版信息
Pediatr Nephrol. 2023 Dec;38(12):4137-4144. doi: 10.1007/s00467-023-06044-3. Epub 2023 Jul 11.
BACKGROUND
We conducted exploratory analyses to identify distinct trajectories of estimated glomerular filtration rate (eGFR) and their relationship with hyperfiltration, subsequent rapid eGFR decline, and albuminuria in participants with youth-onset type 2 diabetes enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.
METHODS
Annual serum creatinine, cystatin C, urine albumin, and creatinine measurements were obtained from 377 participants followed for ≥ 10 years. Albuminuria and eGFR were calculated. Hyperfiltration peak is the greatest eGFR inflection point during follow-up. Latent class modeling was applied to identify distinct eGFR trajectories.
RESULTS
At baseline, participants' mean age was 14 years, type 2 diabetes duration was 6 months, mean HbA1c was 6%, and mean eGFR was 120 ml/min/1.73 m. Five eGFR trajectories associated with different rates of albuminuria were identified, including a "progressive increasing eGFR" group (10%), three "stable eGFR" groups with varying starting mean eGFR, and an "eGFR steady decline" group (1%). Participants who exhibited the greatest peak eGFR also had the highest levels of elevated albuminuria at year 10. This group membership was characterized by a greater proportion of female and Hispanic participants.
CONCLUSIONS
Distinct eGFR trajectories that associate with albuminuria risk were identified, with the eGFR trajectory characterized by increasing eGFR over time associating with the highest level of albuminuria. These descriptive data support the current recommendations to estimate GFR annually in young persons with type 2 diabetes and provide insight into eGFR-related factors which may contribute to predictive risk strategies for kidney disease therapies in youth with type 2 diabetes.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT00081328, date registered 2002. A higher resolution version of the Graphical abstract is available as Supplementary information.
背景
我们进行了探索性分析，以确定青少年 2 型糖尿病患者中肾小球滤过率估计值（eGFR）的不同轨迹及其与高滤过、随后 eGFR 快速下降和白蛋白尿的关系。该研究参与者来自于治疗青少年 2 型糖尿病的选择（TODAY）研究。
方法
对 377 名随访时间≥10 年的患者进行了年度血清肌酐、胱抑素 C、尿白蛋白和肌酐测量。计算白蛋白尿和 eGFR。高滤过峰值是随访过程中 eGFR 的最大拐点。应用潜在类别建模识别不同的 eGFR 轨迹。
结果
基线时，参与者的平均年龄为 14 岁，2 型糖尿病病程为 6 个月，平均糖化血红蛋白为 6%，平均 eGFR 为 120ml/min/1.73m。确定了与不同白蛋白尿率相关的 5 种 eGFR 轨迹，包括“进行性增加 eGFR”组（10%）、3 种不同起始平均 eGFR 的“稳定 eGFR”组和“eGFR 稳定下降”组（1%）。表现出最大峰值 eGFR 的患者在第 10 年也有最高水平的白蛋白尿升高。该组的特点是女性和西班牙裔参与者的比例更高。
结论
确定了与白蛋白尿风险相关的不同 eGFR 轨迹，其中随着时间的推移 eGFR 增加的 eGFR 轨迹与最高水平的白蛋白尿相关。这些描述性数据支持目前每年对 2 型糖尿病年轻患者估算 GFR 的建议，并为可能有助于 2 型糖尿病青少年肾病治疗预测风险策略的 eGFR 相关因素提供了深入了解。
试验注册
ClinicalTrials.gov 标识符：NCT00081328，注册日期 2002 年。图形摘要的更高分辨率版本可作为补充信息获得。
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