夜间低氧血症负荷与2型糖尿病患者慢性肾脏病预后恶化相关。

Nocturnal hypoxemic burden is associated with worsening prognosis of chronic kidney disease in patients with type 2 diabetes.

作者信息

Driendl Sarah, Stadler Stefan, Baumert Mathias, Stark Klaus J, Heid Iris M, Pec Jan, Zeman Florian, Preiss Adrian, Böger Carsten A, Bergler Tobias, Arzt Michael

机构信息

Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.

Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, University of Adelaide, Adelaide, Australia.

出版信息

Cardiovasc Diabetol. 2025 Aug 31;24(1):354. doi: 10.1186/s12933-025-02918-y.

DOI:10.1186/s12933-025-02918-y

PMID:40887593

Abstract

INTRODUCTION

Lower estimated glomerular filtration rate (eGFR) and more severe albuminuria categories are associated with increased risk for adverse outcomes such as mortality, cardiovascular and kidney outcomes. The aim of the analysis was to evaluate whether nocturnal hypoxemic burden (NHB) is associated with worsening prognosis of CKD in a population with T2D.

METHODS

Overnight oximetry data from patients enrolled in the DIACORE (DIAbetes COhoRtE) sleep-disordered breathing sub-study, a prospective cohort study of patients with T2D, was analyzed and NHB as cumulative time spent below 90% oxygen saturation (T90) was quantified. Very-high-risk CKD was defined according to KDIGO risk classification: eGFR < 30 ml/min/1.73 m regardless of urinary albumin-to-creatinine ratio (uACR); eGFR < 45 ml/min/1.73 m and uACR > 30 mg albumin/g creatinine; or eGFR < 60 ml/min/1.73 m and uACR > 300 mg/g. Logistic regression analyses adjusting for known risk factors for CKD prognosis were performed to assess the association between NHB and incident very-high-risk CKD.

RESULTS

The analysis population comprised 857 participants (41% female, mean age 65 years, median diabetes duration 9.0 years, median eGFR 82 ml/min/1.73 m). During follow-up, 72 (8.4%) patients developed very-high-risk CKD, and patients with high T90 significantly more often developed very-high-risk CKD than patients with lower T90 (quartile 4 vs. quartiles 1-3: 15.0 vs. 6.2%, p < 0.001). NHB was significantly associated with an increased incidence of very-high-risk CKD. Patients in the highest quartile of T90 had a 3.0-fold higher risk compared to patients in the lowest quartile, independently of other risk factors for CKD prognosis such as age, sex, waist-hip ratio, hypertension, antihypertensive and lipid-lowering medication, HbA1c, diabetes duration, and eGFR and hemoglobin levels at baseline (OR 2.96, 95% CI (1.24; 7.07), p = 0.014; p for trend 0.013).

CONCLUSION

We identified NHB as a novel risk factor for worsening CKD prognosis in patients with T2D. Further research is needed to ascertain whether T90 reduction constitutes a clinically meaningful prevention target.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010498.

摘要

引言

较低的估算肾小球滤过率（eGFR）和更严重的蛋白尿类别与死亡、心血管和肾脏等不良结局风险增加相关。本分析的目的是评估夜间低氧负荷（NHB）是否与2型糖尿病（T2D）人群中慢性肾脏病（CKD）预后恶化相关。

方法

对参加DIACORE（糖尿病队列研究）睡眠呼吸障碍子研究的患者的夜间血氧饱和度数据进行分析，该研究是一项针对T2D患者的前瞻性队列研究，并对NHB作为低于90%氧饱和度的累积时间（T90）进行量化。极高风险CKD根据KDIGO风险分类定义：无论尿白蛋白与肌酐比值（uACR）如何，eGFR < 30 ml/min/1.73 m²；eGFR < 45 ml/min/1.73 m²且uACR > 30 mg白蛋白/g肌酐；或eGFR < 60 ml/min/1.73 m²且uACR > 300 mg/g。进行了调整CKD预后已知风险因素的逻辑回归分析，以评估NHB与新发极高风险CKD之间的关联。

结果

分析人群包括857名参与者（41%为女性，平均年龄65岁，糖尿病病程中位数9.0年，eGFR中位数82 ml/min/1.73 m²）。在随访期间，72名（8.4%）患者发展为极高风险CKD，T90高的患者比T90低的患者更常发展为极高风险CKD（四分位数4与四分位数1 - 3：15.0%对6.2%，p < 0.001）。NHB与极高风险CKD的发病率增加显著相关。T90最高四分位数的患者与最低四分位数的患者相比，风险高3.0倍，独立于CKD预后的其他风险因素，如年龄、性别、腰臀比、高血压、抗高血压和降脂药物、糖化血红蛋白、糖尿病病程以及基线时的eGFR和血红蛋白水平（比值比2.96，95%置信区间（1.24；7.07），p = 0.014；趋势p值0.013）。