Jia Weiping, Yu Rong, Wang Limin, Zhu Dalong, Guo Lixin, Weng Jianping, Li Hong, Zhang Mei, Ye Xiaoqi, Zhou Zhiguang, Zou Dajin, Ji Qiuhe, Guo Xiaohui, Zhang Yinan, Lang Dong, Wu Jiarui, Wu Jing, Hou Xuhong
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.
Institute for Proactive Healthcare of Shanghai Jiao Tong University, Shanghai, China.
Lancet Reg Health West Pac. 2025 Jan 11;55:101463. doi: 10.1016/j.lanwpc.2024.101463. eCollection 2025 Feb.
To date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes.
A nationally community-based cross-sectional survey was conducted in 2018-2020. 58,560 residents diagnosed with diabetes aged 18-74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m). The latter was calculated using the CKD-EPI equation incorporating serum cystatin C and creatinine. CVH was evaluated using the "life's essential 8" (LE8) score, which ranged from 0 to 100 and included 8 components: diet, sleep duration, physical activity, nicotine exposure, hemoglobin A1c, blood pressure, non-high-density lipoprotein cholesterol, and body mass index. The total LE8 scores were categorized into low (0-49), middle (50-79), and high (80-100) according to the American Heart Association. The associations of albuminuria and decreased eGFR with potential associated factors, including CVH, socioeconomic status, clinical characteristics, sub-regional divisions, comorbidities, treatments, and metabolic controls, were evaluated using survey logistic regression.
The weighted prevalence rates (95% CI) of CKD, albuminuria, and decreased eGFR were 32.6% (31.3%-33.8%), 30.8% (29.6%-32.1%), and 5.5% (5.1%-5.9%), respectively. Among those with CKD, 25.7% had diabetic retinopathy (DR) and 22.3% had cardiovascular disease (CVD). The weighted prevalence rates of albuminuria and decreased eGFR were consistently higher among southern residents, rural residents, and individuals with more severe DR and a history of CVD than their counterparts (all p < 0.05). After adjustment for age, sex, sub-regional division, setting, educational level, annual household income, family history of diabetes, diabetes duration, glucose-lowering treatment, any DR, CVD, and drinking status, the logistic models showed that the odds ratios (ORs) (95% CI) for albuminuria and decreased eGFR were 0.46 (0.42-0.51) and 0.61 (0.55-0.67) for the participants with moderate scores, and 0.14 (0.10-0.21) and 0.28 (0.19-0.41) for those with high scores, compared with those with low total LE8 scores. Furthermore, the restricted cubic spline curves depicted that the disparities in the odds of having albuminuria or decreased eGFR among subpopulations grouped by sex, age, setting, and geographical region, significantly decreased and even disappeared in some cases as the LE8 scores increased.
Chinese adults with diabetes are heavily burdened by CKD. Optimized CVH is central to reducing CKD risk across different subpopulations.
National Key Clinical Specialty, the Chinese Academy of Engineering.
迄今为止，缺乏关于中国成年糖尿病患者中慢性肾脏病（CKD）分布情况的全面数据，CKD是糖尿病中最常见的合并症。此外，在全国范围内的成年糖尿病患者样本中，对于理解CKD与心血管健康（CVH，生活方式和代谢控制的综合指标）之间的关联还存在研究空白。
2018 - 2020年开展了一项全国性的基于社区的横断面调查。邀请了全国58560名年龄在18 - 74岁且被诊断为糖尿病的居民参与，本研究纳入了52000名具有完整CKD数据的参与者。CKD通过蛋白尿（尿白蛋白与肌酐比值≥30mg/g）和/或估算肾小球滤过率降低（eGFR，<60mL/min/1.73m²）来确定。后者使用包含血清胱抑素C和肌酐的CKD - EPI方程进行计算。CVH使用“生命八大要素”（LE8）评分进行评估，评分范围为0至100分，包括8个组成部分：饮食、睡眠时间、身体活动、尼古丁暴露、糖化血红蛋白、血压、非高密度脂蛋白胆固醇和体重指数。根据美国心脏协会的标准，将LE8总分分为低（0 - 49分）、中（50 - 79分）和高（80 - 100分）三个类别。使用调查逻辑回归评估蛋白尿和eGFR降低与潜在相关因素之间的关联，这些因素包括CVH、社会经济状况、临床特征、地区划分、合并症、治疗情况和代谢控制情况。
CKD、蛋白尿和eGFR降低的加权患病率（95%CI）分别为32.6%（31.3% - 33.8%）、30.8%（29.6% - 32.1%）和5.5%（5.1% - 5.9%）。在患有CKD的患者中，25.7%患有糖尿病视网膜病变（DR），22.3%患有心血管疾病（CVD）。南方居民、农村居民以及患有更严重DR和有CVD病史的个体中，蛋白尿和eGFR降低的加权患病率始终高于其对应人群（所有p < 0.05）。在对年龄、性别、地区划分、环境、教育水平、家庭年收入、糖尿病家族史、糖尿病病程、降糖治疗、任何DR、CVD和饮酒状况进行调整后，逻辑模型显示，与LE8总分低的参与者相比，LE8评分中等的参与者出现蛋白尿和eGFR降低的比值比（OR）（95%CI）分别为0.46（0.42 - 0.51）和0.61（0.55 - 0.67），LE8评分高的参与者的OR分别为0.14（0.10 - 0.21）和0.28（0.19 - 0.41）。此外，受限立方样条曲线表明，按性别、年龄、环境和地理区域分组的亚人群中，出现蛋白尿或eGFR降低的几率差异随着LE8评分的增加而显著减小，在某些情况下甚至消失。
中国成年糖尿病患者承受着CKD的沉重负担。优化CVH对于降低不同亚人群的CKD风险至关重要。
国家重点临床专科，中国工程院。
