Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Nephrology, 33000 Bordeaux, France.
Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Nephrology, 33000 Bordeaux, France.
Diabetes Metab. 2024 Jul;50(4):101536. doi: 10.1016/j.diabet.2024.101536. Epub 2024 May 1.
Diabetic kidney disease favors diabetic foot ulcers, however we do not know whether the reverse relation exists. We investigated whether diabetic foot disease (DFD) related to an increased risk of developing renal events.
We conducted a retrospective analysis of a cohort of patients hospitalized for type 2 diabetes mellitus (T2DM) between 2009 and 2017, stratified for the risk of diabetic foot ulcer grades 0 (no risk), 1 and 2 (at risk), and 3 (DFD) according to the International Work Group on Diabetic Foot (IWGDF) classification. We highlighted new renal events (end-stage renal disease or a doubling of serum creatinine) in their medical records until December 2020. The relationship between DFD and later renal events was analyzed by multivariable Cox regression model.
Among 519 patients, 142 (27 %) had a DFD at baseline, and 159 (30 %) were classified as Grades 1 or 2. Thirty-six renal events occurred during the 54 ± 27 months of follow-up: 19 subjects started dialysis, 1 had a renal transplantation, and 16 had a doubling of serum creatinine: 15 each in subjects with DFD and subjects at risk, versus 6 in subjects with Grade 0 DFD (logrank: P = 0.001). Adjusted for i) age and sex; ii) hyperglycemic exposure; iii) conventional cardiovascular risk factors; iv) renal parameters: and v) new diabetic foot ulcers during follow-up, DFD (HR 2.7 to 5.9) and being at risk of DFD Grades 1-2 (HR 2.8 to 5.1) were significantly related to new renal events.
The risk of renal events was increased in people with T2DM and DFD.
糖尿病肾病有利于糖尿病足溃疡，但我们不知道这种反向关系是否存在。我们调查了糖尿病足疾病（DFD）是否与发生肾脏事件的风险增加有关。
我们对 2009 年至 2017 年间因 2 型糖尿病住院的患者队列进行了回顾性分析，根据国际糖尿病足工作组（IWGDF）分类，将患者分为糖尿病足溃疡 0 级（无风险）、1 级和 2 级（有风险）和 3 级（DFD）。我们在病历中突出显示了新的肾脏事件（终末期肾病或血清肌酐加倍），直到 2020 年 12 月。使用多变量 Cox 回归模型分析 DFD 与晚期肾脏事件之间的关系。
在 519 名患者中，142 名（27%）在基线时有 DFD，159 名（30%）被分类为 1 级或 2 级。在 54±27 个月的随访中发生了 36 例肾脏事件：19 例开始透析，1 例进行了肾移植，16 例血清肌酐加倍：DFD 组和有风险的患者各有 15 例，而 DFD 0 级的患者有 6 例（logrank：P=0.001）。调整年龄和性别；ii）高血糖暴露；iii）传统心血管危险因素；iv）肾脏参数；和 v）随访期间新发的糖尿病足溃疡后，DFD（HR 2.7 至 5.9）和处于 1-2 级 DFD 风险（HR 2.8 至 5.1）与新发肾脏事件显著相关。
患有 2 型糖尿病和 DFD 的人发生肾脏事件的风险增加。
