Michel Mathis, Flahault Adrien, Coliche Vladimir, Alla Asma, Testevuide Pascale, Delaval Ronan, Chatziantoniou Christos, Frimat Luc, Sartelet Hervé, Kormann Raphaël
Department of Nephrology, Université de Lorraine, CHRU-Nancy, Nancy, France.
Department of Pathology, Université de Lorraine, CHRU-Nancy, Nancy, France.
Diabetologia. 2025 Jun 27. doi: 10.1007/s00125-025-06471-x.
AIMS/HYPOTHESIS: Māori, a Polynesian population, have an earlier age of onset of type 2 diabetes and higher risk of diabetes-related complications compared with New Zealanders of European descent, and an increased incident rate ratio for end stage kidney disease. No data are available regarding the evolutive characteristics of diabetic kidney disease (DKD) in individuals living in French Polynesia.
We aimed to compare the retrospectively collected characteristics and outcomes of 92 and 63 individuals from French Polynesia and mainland France, respectively, presenting type 2 diabetes and biopsy-confirmed DKD, focusing on kidney survival, analysis of the Renal Pathology Society (RPS) score and participant survival.
At the time of biopsy, Polynesian participants were younger (56.5 vs 66.9 years, p<0.001) and had a higher urinary protein/creatinine ratio (uPCR) (792 vs 452 mg/mmol, p<0.001), despite similar anti-proteinuria treatments and eGFR, and shorter time since diabetes diagnosis (8.7 vs 11.1 years, p=0.008). Polynesian participants had a more severe RPS classification (p<0.001). Median time from biopsy to kidney failure with replacement therapy was 1.59 years in the Polynesian population and 6.06 years in the mainland French population, accounting for death as a competing risk. Polynesian participants were at a higher risk of end stage kidney disease after adjustment for uPCR, eGFR, BMI and age at baseline (HR 2.45 [95% CI 1.23, 4.88]). In a clinical and histological reduced multivariable model, Polynesian origin, higher uPCR, lower eGFR, more severe RPS classification and presence of chronic vascular lesions were all independently associated with poorer kidney survival. The RPS classification was more strongly associated with kidney survival in participants from Polynesia (p value for interaction, 0.048), while a higher uPCR was more strongly associated with kidney survival in participants from mainland France (p value for interaction, <0.001). Older age and Polynesian origin were also independent risk factors for death.
CONCLUSIONS/INTERPRETATION: Starting at an earlier age, the evolutive course of DKD is also more severe in individuals from French Polynesia than from mainland Western Europe. Strong differences in clinical, histological and predictive outcomes of diabetic nephropathy were found in these different ethnic groups.
目的/假设：与欧洲裔新西兰人相比，波利尼西亚人群毛利人患2型糖尿病的发病年龄更早，糖尿病相关并发症风险更高，终末期肾病的发病率比值也更高。目前尚无关于法属波利尼西亚居民糖尿病肾病（DKD）演变特征的数据。
我们旨在比较分别来自法属波利尼西亚和法国本土的92例和63例2型糖尿病且经活检确诊为DKD患者的回顾性收集特征和结局，重点关注肾脏生存率、肾脏病理学会（RPS）评分分析和参与者生存率。
活检时，波利尼西亚参与者更年轻（56.5岁对66.9岁，p<0.001），尿蛋白/肌酐比值（uPCR）更高（792对452mg/mmol，p<0.001），尽管抗蛋白尿治疗和估算肾小球滤过率（eGFR）相似，且糖尿病诊断后的时间更短（8.7年对11.1年，p=0.008）。波利尼西亚参与者的RPS分类更严重（p<0.001）。在波利尼西亚人群中，从活检到需要替代治疗的肾衰竭的中位时间为1.59年，在法国本土人群中为6.06年，将死亡作为竞争风险因素考虑在内。在对uPCR、eGFR、体重指数（BMI）和基线年龄进行调整后，波利尼西亚参与者发生终末期肾病的风险更高（风险比2.45[95%置信区间1.23，4.88]）。在一个临床和组织学简化多变量模型中，波利尼西亚血统、更高的uPCR、更低的eGFR、更严重的RPS分类以及慢性血管病变的存在均与较差的肾脏生存率独立相关。RPS分类与来自法属波利尼西亚的参与者的肾脏生存率关联更强（交互作用p值为0.048），而更高的uPCR与来自法国本土的参与者的肾脏生存率关联更强（交互作用p值<0.001）。年龄较大和波利尼西亚血统也是死亡的独立危险因素。
结论/解读：从更早的年龄开始，法属波利尼西亚个体的DKD演变过程也比西欧本土个体更严重。在这些不同种族群体中，糖尿病肾病的临床、组织学和预测结局存在显著差异。
