Sang Dasen, Tao Jie, Song Wanqing, Zhang Qi, Wu Shouling, Geng Wei
Department of Cardiology, Baoding NO. 1 Central Hospital, N0. 320, Changcheng Street, Baoding, Hebei, China.
Department of Cardiology, Tangshan Gongren Hospital Affiliated to Hebei Medical University, Tangshan, Hebei, 063000, China.
Diabetol Metab Syndr. 2024 Sep 12;16(1):225. doi: 10.1186/s13098-024-01461-2.
This study aimed to investigate the impact of different estimated glomerular filtration rate (eGFR) values like cystatin C-based eGFR (eGFRcys), creatinine-based eGFR (eGFRcr), and their difference (eGFRdiff; eGFRcys -eGFRcr), on the incidence of heart failure (HF) in patients with type 2 diabetes(T2D).
Being a prospective cohort study, it included 7,967 patients with T2D who underwent serum creatinine and cystatin C tests as part of the Kailuan Group's 6th annual health examination (2016). Subsequently, eGFRcys, eGFRcr, and eGFRdiff were calculated. Patients were categorized into three groups: negative (<-15 mL/min/1.73 m), midrange (-15 to 15 mL/min/1.73 m), and positive (> 15 mL/min/1.73 m) eGFRdiff groups, respectively. Furthermore, the relationship between the various eGFR measurements and new-onset HF were studied using Cox proportional hazards regression, and the potential improvement in predictive capability was evaluated by adding these eGFR metrics to established HF risk models.
Among 7967 participants with mean age of 60.51 years, there were 20.92% women and 79.08% men. At baseline, eGFRcys and eGFRcr values differed by more than 15 mL/min/1.73m in 41.3% of participants. During a median follow-up period of 3.76 years, there were 172 (2.16%) new HF cases and 517 (6.49%) all-cause deaths. The cumulative incidence of HF in the midrange, negative, and positive eGFRdiff groups was 1.74%, 4.10%, and 0.61%, respectively (p < 0.001). In multivariable adjusted models, participants in the negative eGFRdiff group had higher risk of HF compared with the midrange eGFRdiff group (HR, 2.15; 95% CI, 1.57-2.94). Conversely, participants in the positive eGFRdiff group had lower risk for HF (HR, 0.40; 95% CI, 0.17-0.93). And each 15 mL/min/ 1.73 m higher eGFRdiff was associated with 34% (HR, 0.66; 95% CI, 0.58 - 0.47)lower risk of incident HF. The predictive capacity for HF risk in diabetic individuals was enhanced by adding eGFRcys or eGFRdiff to established HF risk models, with eGFRcys showing more significant additional predictive value.
These findings suggest that large differences between eGFRcys and eGFRcr were common in community-based population with T2D. Different eGFR metrics can independently predict HF incidence in patients with T2D. Additionally, metrics like eGFRcys and eGFRdiff provide significant predictive value for HF risks beyond traditional risk factors, with eGFRcys showing more pronounced benefits in such cases.
本研究旨在探讨不同估算肾小球滤过率（eGFR）值，如基于胱抑素C的eGFR（eGFRcys）、基于肌酐的eGFR（eGFRcr）及其差值（eGFRdiff；eGFRcys - eGFRcr）对2型糖尿病（T2D）患者心力衰竭（HF）发生率的影响。
作为一项前瞻性队列研究，该研究纳入了7967例T2D患者，这些患者作为开滦集团第6次年度健康检查（2016年）的一部分接受了血清肌酐和胱抑素C检测。随后计算eGFRcys、eGFRcr和eGFRdiff。患者分别被分为三组：eGFRdiff阴性（<-15 mL/min/1.73 m²）、中等范围（-15至15 mL/min/1.73 m²）和阳性（>15 mL/min/1.73 m²）组。此外，使用Cox比例风险回归研究各种eGFR测量值与新发HF之间的关系，并通过将这些eGFR指标添加到已建立的HF风险模型中来评估预测能力的潜在改善。
在7967名平均年龄为60.51岁的参与者中，女性占20.92%，男性占79.08%。在基线时，41.3%的参与者eGFRcys和eGFRcr值相差超过15 mL/min/1.73m²。在中位随访期3.76年期间，有172例（2.16%）新发HF病例和517例（6.49%）全因死亡。eGFRdiff中等范围、阴性和阳性组的HF累积发生率分别为1.74%、4.10%和0.61%（p<0.001）。在多变量调整模型中，与eGFRdiff中等范围组相比，eGFRdiff阴性组的参与者发生HF的风险更高（HR，2.15；95%CI，1.57 - 2.94）。相反，eGFRdiff阳性组的参与者发生HF的风险较低（HR，0.40；95%CI，0.17 - 0.93）。并且eGFRdiff每升高15 mL/min/1.73 m²与HF发生风险降低34%（HR，0.66；95%CI，0.58 - 0.47）相关。通过将eGFRcys或eGFRdiff添加到已建立的HF风险模型中，糖尿病个体HF风险的预测能力得到增强，其中eGFRcys显示出更显著的额外预测价值。
这些发现表明，在以社区为基础的T2D人群中，eGFRcys和eGFRcr之间的巨大差异很常见。不同的eGFR指标可以独立预测T2D患者的HF发生率。此外，eGFRcys和eGFRdiff等指标为HF风险提供了超越传统风险因素的显著预测价值，在这种情况下eGFRcys显示出更明显的益处。
