Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
Diabetes Care. 2024 May 1;47(5):873-880. doi: 10.2337/dc23-2364.
The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We investigated the associations of eGFRdiff with overall DMCs and subtypes, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN).
This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes.
During a median follow-up of 13.6 years, DMCs developed in 5,753 participants, including 2,752 cases of DR, 3,203 of DKD, and 1,149 of DN. Each SD decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10% decrease in eGFRrediff, the corresponding hazard ratios (95% CIs) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN. The magnitude of associations was not materially altered in any of the sensitivity analyses.
Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff in the diabetes population has potential benefit for identification of high-risk patients.
胱抑素 C-和基于肌酐的估算肾小球滤过率（eGFRdiff）之间的差异对糖尿病微血管并发症（DMCs）的影响尚不清楚。我们研究了 eGFRdiff 与整体 DMCs 及其亚型的相关性，包括糖尿病视网膜病变（DR）、糖尿病肾病（DKD）和糖尿病神经病变（DN）。
本前瞻性队列研究纳入了 2006 年至 2010 年间英国生物库中无 DMCs 的 25825 名糖尿病患者。使用胱抑素 C-和基于肌酐的计算之间的绝对差异（eGFRabdiff）和比值（eGFRrediff）来计算 eGFRdiff。使用电子健康记录确定 DMCs 的发病情况。使用 Cox 比例风险回归模型评估 eGFRdiff 与整体 DMCs 和亚型的相关性。
在中位随访 13.6 年期间，5753 名参与者发生了 DMCs，包括 2752 例 DR、3203 例 DKD 和 1149 例 DN。eGFRabdiff 每降低 1 个标准差，整体 DMCs 的风险增加 28%，DR 的风险增加 14%，DKD 的风险增加 56%，DN 的风险增加 29%。eGFRrediff 每降低 10%，相应的危险比（95%CI）分别为整体 DMCs 1.16（1.14，1.18）、DR 1.08（1.05，1.11）、DKD 1.29（1.26，1.33）和 DN 1.17（1.12，1.22）。在任何敏感性分析中，关联的幅度均未发生实质性改变。
较大的 eGFRdiff 与 DMCs 及其亚型的风险独立相关。我们的研究结果表明，在糖尿病患者中监测 eGFRdiff 可能有助于识别高危患者。
