Janota-Sosińska Oliwia, Mantovani Marta, Irlik Krzysztof, Kwiendacz Hanna, Olejarz Anna, Pabis Patrycja, Włosowicz-Momot Aleksandra, Piaśnik Julia, Wójcik Wiktoria, Szromek-Białek Paulina, Alam Uazman, Gumprecht Janusz, Lip Gregory Y H, Nabrdalik Katarzyna
Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Doctoral School, Medical University of Silesia, Katowice, Poland.
Cardiovasc Diabetol. 2025 Jul 30;24(1):305. doi: 10.1186/s12933-025-02852-z.
The impact of diabetic kidney disease (DKD) phenotype on the cardiovascular (CV) risk remains ambiguous.
This was a prospective, single-center study (The Silesia Diabetes-Heart Project, NCT05626413) of people with diabetes mellitus (DM). The primary outcome was a composite of CV events during a median follow up of 2.8 years (IQR 1.7; 4.0). Individuals were divided into groups based on DKD phenotypes [reduced estimated glomerular filtration rate (eGFR) (< 60 mL/min/1.73 m), and/or elevated urinary albumin creatinine ratio (UACR) (≥ 30 mg/g)] and compared to those without DKD.
Among 2306 people with DM (mean age 58 ± 18 years, 51.9% males) those with DKD had higher CV events risk (aHR 1.02, 95% CI 1.01-1.03) compared to those without DKD. People with reduced eGFR (aHR 1.78, 95% CI 1.19-2.67) and those with reduced eGFR and elevated UACR (aHR 1.60, 95% CI 1.08-2.37) were at higher risk of CV events compared to people with normal eGFR and UACR, while people with elevated UACR only (aHR 0.91, 95% CI 0.62-1.32) did not had the risk heightened. Among people with DKD less frequent prescriptions with sodium-glucose co-transporter 2 inhibitors and renin-angiotensin-aldosterone system inhibitors were observed (OR 0.38, 95% CI 0.29-0.49, p < 0.001 and OR 0.39, 95% CI 0.30-0.50, p < 0.001, respectively) compared with the ones without DKD.
People with DKD, with reduced eGFR or both reduced eGFR and elevated UACR, but not with elevated UACR alone, are at higher CV risk. Personalizing therapy based on clinic-based renal phenotyping can facilitate the initiation of CV disease modifying therapy.
糖尿病肾病（DKD）表型对心血管（CV）风险的影响仍不明确。
这是一项针对糖尿病（DM）患者的前瞻性单中心研究（西里西亚糖尿病 - 心脏项目，NCT05626413）。主要结局是在中位随访2.8年（四分位间距1.7；4.0）期间的心血管事件复合终点。个体根据DKD表型[估计肾小球滤过率（eGFR）降低（<60 mL/min/1.73 m²）和/或尿白蛋白肌酐比值（UACR）升高（≥30 mg/g）]进行分组，并与无DKD的个体进行比较。
在2306例糖尿病患者中（平均年龄58±18岁，男性占51.9%），与无DKD的患者相比，DKD患者发生心血管事件的风险更高（调整后风险比[aHR] 1.02，95%置信区间[CI] 1.01 - 1.03）。与eGFR和UACR正常的患者相比，eGFR降低的患者（aHR 1.78，95% CI 1.19 - 2.67）以及eGFR降低且UACR升高的患者（aHR 1.60，95% CI 1.08 - 2.37）发生心血管事件的风险更高，而仅UACR升高的患者（aHR 0.91，95% CI 0.62 - 1.32）风险未升高。在DKD患者中，观察到钠 - 葡萄糖协同转运蛋白2抑制剂和肾素 - 血管紧张素 - 醛固酮系统抑制剂的处方频率低于无DKD的患者（分别为比值比[OR] 0.38，95% CI 0.29 - 0.49，p < 0.001和OR 0.39，95% CI 0.30 - 0.50，p < 0.001）。
患有DKD且eGFR降低或eGFR降低同时UACR升高但非仅UACR升高的患者心血管风险更高。基于临床肾脏表型进行个性化治疗有助于启动改善心血管疾病的治疗。
