Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan.
Shirakawa Kosei General Hospital, Fukushima, Japan.
J Diabetes Investig. 2024 Oct;15(10):1444-1456. doi: 10.1111/jdi.14272. Epub 2024 Jul 26.
AIMS/INTRODUCTION: The time course of chronic kidney disease in young-onset type 2 diabetes mellitus remains unclear. We compared the trajectories of proteinuria and estimated glomerular filtration rate (eGFR) decline between young-onset (aged ≤40 years) and late-onset (aged >40 years) type 2 diabetes mellitus in a Japanese multicenter cohort.
Participants without diabetic kidney disease were divided into two groups according to age at diagnosis: young- and late-onset. The primary endpoint was eGFR <60 mL/min/1.73 m, proteinuria or both. Multivariable Cox proportional hazards were calculated to estimate incidence.
Among 626 participants with type 2 diabetes mellitus, 78 (12.4%) had young-onset and 548 (87.6%) had late-onset diabetes. The incidence of eGFR <60 mL/min/1.73 m was lower (16.7% vs 33.5%, P = 0.003), but that of proteinuria was higher (46.2% vs 28.9%, P = 0.002) in the young-onset type 2 diabetes mellitus group. The Kaplan-Meyer curve showed that young-onset type 2 diabetes mellitus was associated with a decreased hazard ratio (HR) for eGFR <60 mL/min/1.73 m and an increased HR for proteinuria compared with late-onset type 2 diabetes mellitus. In the multivariate Cox analysis, young-onset type 2 diabetes mellitus increased the HR (95% confidence interval) of proteinuria (1.53, 95% confidence interval 1.03-2.26), but did not change the eGFR <60 mL/min/1.73 m HR.
Young-onset type 2 diabetes mellitus has a lower HR of eGFR <60 mL/min/1.73 m and an increased HR of proteinuria compared with late-onset type 2 diabetes mellitus, indicating that young-onset type 2 diabetes mellitus has a different time course for the development of proteinuria and subsequent eGFR decline.
目的/引言：年轻起病的 2 型糖尿病患者慢性肾脏病的病程尚不清楚。我们比较了日本多中心队列中年轻起病（年龄≤40 岁）和晚起病（年龄＞40 岁）2 型糖尿病患者蛋白尿和估算肾小球滤过率（eGFR）下降的轨迹。
无糖尿病肾病的参与者根据诊断时的年龄分为两组：年轻起病和晚起病。主要终点为 eGFR<60 mL/min/1.73 m、蛋白尿或两者兼有。采用多变量 Cox 比例风险评估估计发病率。
在 626 名 2 型糖尿病患者中，78 名（12.4%）为年轻起病，548 名（87.6%）为晚起病。eGFR<60 mL/min/1.73 m 的发生率较低（16.7% vs 33.5%，P=0.003），但年轻起病 2 型糖尿病患者的蛋白尿发生率较高（46.2% vs 28.9%，P=0.002）。Kaplan-Meier 曲线显示，与晚起病 2 型糖尿病相比，年轻起病 2 型糖尿病与 eGFR<60 mL/min/1.73 m 的风险比降低和蛋白尿的风险比增加相关。在多变量 Cox 分析中，年轻起病 2 型糖尿病增加了蛋白尿的风险比（95%置信区间）（1.53，95%置信区间 1.03-2.26），但未改变 eGFR<60 mL/min/1.73 m 的风险比。
与晚起病 2 型糖尿病相比，年轻起病 2 型糖尿病的 eGFR<60 mL/min/1.73 m 风险比降低，蛋白尿风险比增加，表明年轻起病 2 型糖尿病患者蛋白尿和随后的 eGFR 下降的发展具有不同的时间过程。
