肾小球高滤过对2型糖尿病患者心血管疾病发病的影响。
Effect of Glomerular Hyperfiltration on Incident Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus.
作者信息
Chung Seung Min, Jung Inha, Lee Da Young, Park So Young, Yu Ji Hee, Moon Jun Sung, Seo Ji A, Han Kyung-Do, Kim Nan Hee
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
出版信息
Clin J Am Soc Nephrol. 2025 Mar 1;20(3):410-419. doi: 10.2215/CJN.0000000618. Epub 2025 Jan 9.
KEY POINTS
Patients with type 2 diabetes mellitus who had glomerular hyperfiltration (GHF) were younger and had fewer comorbid metabolic disorders, despite poor glycemic control. The relationship between eGFR and incident cardiovascular disease showed an inverted J-shaped pattern, which was highest among low filtration, followed by GHF. GHF was associated with a higher risk of cardiovascular disease, particularly myocardial infarction and heart failure.
BACKGROUND
The effects of glomerular hyperfiltration (GHF) on cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus were explored.
METHODS
This retrospective cohort study enrolled 1,952,053 patients with type 2 diabetes mellitus from the Korean National Health Insurance Service database between 2015 and 2016. On the basis of age- and sex-specific eGFR percentiles, patients were classified into five groups: <5 (low filtration), 5–40, 40–60, 60–95, and >95 (GHF). Patients with incident CVD (myocardial infarction [MI], stroke, and hospitalization for heart failure) were followed up until December 2022.
RESULTS
CVD occurred in 214,111 patients (11%). The incidence rates were 36.1, 20.8, 18.3, 18.7, and 19.3 per 1000 person-years for the eGFR groups, respectively. Low filtration (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.53 to 1.59) and GHF (HR, 1.13; 95% CI, 1.10 to 1.15) were associated with higher CVD risk adjusted for covariates than that of the eGFR 40–60 percentile, showing an inverted J-shaped relationship. GHF was associated with a higher risk of MI (HR, 1.06; 95% CI, 1.01 to 1.11) and heart failure (HR, 1.17; 95% CI, 1.14 to 1.20) and with a higher risk of stroke. eGFR was associated with CVD risk across subgroups of age, sex, obesity, hypertension, and dyslipidemia. The effect of GHF on CVD may be greater in younger patients (HR=1.30, 1.17, and 1.05 in <40, 40–60, and ≥65 years old, respectively).
CONCLUSIONS
GHF was associated with CVD, particularly MI and heart failure. Screening for GHF in the early stages of type 2 diabetes mellitus may be beneficial.
要点
尽管血糖控制不佳，但存在肾小球高滤过（GHF）的2型糖尿病患者更年轻，合并的代谢紊乱也更少。估算肾小球滤过率（eGFR）与心血管疾病发生率之间呈倒J形关系，在低滤过组中最高，其次是GHF组。GHF与心血管疾病风险较高相关，尤其是心肌梗死和心力衰竭。
背景
探讨肾小球高滤过（GHF）对2型糖尿病患者心血管疾病（CVD）风险的影响。
方法
这项回顾性队列研究纳入了2015年至2016年韩国国民健康保险服务数据库中的1,952,053例2型糖尿病患者。根据年龄和性别特异性eGFR百分位数，患者被分为五组：<5（低滤过）、5 - 40、40 - 60、60 - 95和>95（GHF）。对发生CVD（心肌梗死[MI]、中风和因心力衰竭住院）的患者进行随访至2022年12月。
结果
214,111例患者（11%）发生了CVD。eGFR分组每1000人年的发病率分别为36.1、20.8、18.3、18.7和19.3。与eGFR 40 - 60百分位数组相比，低滤过（风险比[HR]，1.56；95%置信区间[CI]，1.53至1.59）和GHF（HR，1.13；95% CI，1.10至1.15）在调整协变量后与更高的CVD风险相关，呈现倒J形关系。GHF与更高的MI风险（HR，1.06；95% CI，1.01至1.11）、心力衰竭风险（HR，1.17；95% CI，1.14至1.20）以及更高的中风风险相关。eGFR在年龄、性别、肥胖、高血压和血脂异常的亚组中均与CVD风险相关。GHF对CVD的影响在年轻患者中可能更大（<40岁、40 - 60岁和≥65岁的HR分别为1.30、1.17和1.05）。
结论
GHF与CVD相关，尤其是MI和心力衰竭。在2型糖尿病早期筛查GHF可能有益。
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