Suppr
超能文献

2 型糖尿病患者的心力衰竭事件及其随后进展为终末期肾病的风险。

Incident heart failure and the subsequent risk of progression to end stage kidney disease in individuals with type 2 diabetes.

机构信息

Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 768828, Singapore.

Cardiovascular and Metabolic Disorders Signature Research Program, DUKE-NUS Medical School, Singapore, 169857, Singapore.

出版信息

Cardiovasc Diabetol. 2024 Jun 15;23(1):204. doi: 10.1186/s12933-024-02279-y.

DOI:10.1186/s12933-024-02279-y

PMID:38879473

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11180396/

Abstract

BACKGROUND

Diabetic kidney disease is an established risk factor for heart failure. However, the impact of incident heart failure on the subsequent risk of renal failure has not been systematically assessed in diabetic population. We sought to study the risk of progression to end stage kidney disease (ESKD) after incident heart failure in Asian patients with type 2 diabetes.

METHODS

In this prospective cohort study, 1985 outpatients with type 2 diabetes from a regional hospital and a primary care facility in Singapore were followed for a median of 8.6 (interquartile range 6.2-9.6) years. ESKD was defined as a composite of progression to sustained eGFR below 15 ml/min/1.73m2, maintenance dialysis or renal death, whichever occurred first.

RESULTS

180 incident heart failure events and 181 incident ESKD events were identified during follow-up. Of 181 ESKD events, 38 (21%) occurred after incident heart failure. Compared to those did not progress to ESKD after incident heart failure (n = 142), participants who progressed to ESKD after heart failure occurrence were younger, had higher HbA1c and higher urine albumin-to-creatinine ratio at baseline. The excess risk of ESKD manifested immediately after heart failure occurrence, persisted for two years and was moderated thereafter. Cox regression suggested that, compared to counterparts with no heart failure event, participants with heart failure occurrence had 9.6 (95% CI 5.0- 18.3) fold increased risk for incident ESKD after adjustment for baseline cardio-renal risk factors including eGFR and albuminuria. It appeared that heart failure with preserved ejection fraction had a higher risk for ESKD as compared to those with reduced ejection fraction (adjusted HR 13.7 [6.3-29.5] versus 6.5 [2.3-18.6]).

CONCLUSION

Incident heart failure impinges a high risk for progression to ESKD in individuals with type 2 diabetes. Our data highlight the need for intensive surveillance of kidney function after incident heart failure, especially within the first two years after heart failure diagnosis.

摘要

背景

糖尿病肾病是心力衰竭的既定危险因素。然而，在糖尿病患者中，心力衰竭事件对随后肾衰竭风险的影响尚未得到系统评估。我们旨在研究亚洲 2 型糖尿病患者心力衰竭事件后进展为终末期肾病（ESKD）的风险。

方法

在这项前瞻性队列研究中，我们对新加坡一家区域医院和初级保健机构的 1985 名 2 型糖尿病门诊患者进行了随访，中位随访时间为 8.6 年（四分位距 6.2-9.6 年）。ESKD 的定义为持续估算肾小球滤过率（eGFR）降至 15 ml/min/1.73m2 以下、维持透析或肾脏死亡的复合终点，以先发生者为准。

结果

随访期间共发生 180 例心力衰竭事件和 181 例 ESKD 事件。在 181 例 ESKD 事件中，38 例（21%）发生在心力衰竭事件之后。与心力衰竭事件后未进展为 ESKD 的患者（n=142）相比，心力衰竭后进展为 ESKD 的患者年龄较小，基线时的糖化血红蛋白和尿白蛋白/肌酐比值较高。心力衰竭发生后，ESKD 的风险即刻增加，并持续 2 年，此后逐渐降低。Cox 回归分析表明，在校正基线心肾危险因素（包括 eGFR 和白蛋白尿）后，与无心力衰竭事件的患者相比，发生心力衰竭的患者发生 ESKD 的风险增加了 9.6 倍（95%CI 5.0-18.3）。心力衰竭伴有射血分数保留的患者发生 ESKD 的风险似乎高于射血分数降低的患者（校正 HR 13.7 [6.3-29.5] 与 6.5 [2.3-18.6]）。