Russo Giuseppina Tiziana, Giandalia Annalisa, Lucisano Giuseppe, Rossi Maria Chiara, Piscitelli Pamela, Pontremoli Roberto, Viazzi Francesca, Rocca Alberto, Manicardi Valeria, Di Cianni Graziano, Candido Riccardo, Nicolucci Antonio, De Cosmo Salvatore
Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy.
Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy.
Eur J Intern Med. 2024 Dec;130:123-129. doi: 10.1016/j.ejim.2024.07.034. Epub 2024 Aug 10.
Diabetic kidney disease is the most common cause of end-stage kidney disease (ESKD) in the western world. Rapid estimated glomerular filtration rate (eGFR) decline is an independent predictor of ESKD and death in the general population and in subjects with type 2 diabetes mellitus (T2D).
We investigated in a large sample of subjects with newly diagnosed T2D the prevalence and clinical determinants of fast eGFR decline, taking advantage from the dataset of the Associazione Medici Diabetologi (AMD) Annals initiative.
The eGFR trajectories were evaluated by applying a linear mixed model for repeated measures (LMMRM) and rapid eGFR decline defined as an eGFR decline greater than 5 mL/min/1.73 m2 per year at 3 years.
Among 105,163 (57.7% M) subjects with newly diagnosed T2D, 13,587 (12.9 %) subjects showed a rapid eGFR loss. The independent significant predictors were age, female gender, HbA1c, smoking, high baseline eGFR, albuminuria and retinopathy.
Our study demonstrates that a significant percentage of newly diagnosed T2D subjects have a rapid eGFR decline. Given the association between dynamic changes in eGFR and the risk of ESKD or death, we suggest to include this variable in the definition of CKD.
在西方世界，糖尿病肾病是终末期肾病（ESKD）最常见的病因。快速的估算肾小球滤过率（eGFR）下降是普通人群以及2型糖尿病（T2D）患者发生ESKD和死亡的独立预测因素。
我们利用糖尿病医生协会（AMD）年鉴计划的数据集，在大量新诊断的T2D患者样本中，研究了快速eGFR下降的患病率及其临床决定因素。
通过应用重复测量的线性混合模型（LMMRM）评估eGFR轨迹，并将快速eGFR下降定义为3年内eGFR下降大于5 mL/min/1.73 m²/年。
在105,163名（57.7%为男性）新诊断的T2D患者中，13,587名（12.9%）患者出现了快速的eGFR下降。独立的显著预测因素为年龄、女性、糖化血红蛋白、吸烟、高基线eGFR、蛋白尿和视网膜病变。
我们的研究表明，相当比例的新诊断T2D患者存在快速的eGFR下降。鉴于eGFR的动态变化与ESKD或死亡风险之间的关联，我们建议将该变量纳入慢性肾脏病的定义中。
