JCEM:糖尿病前期与CKD进展和不良心血管结局的关联

2020-01-18 xing.T MedSci原创

在CKD患者中,糖尿病前期与复合肾结局无关,但与蛋白尿进展和CV不良风险增加有关。

尽管糖尿病被认为是进展性肾脏疾病和心脏并发症的已知危险因素,但糖尿病前期患者在慢性肾脏疾病(CKD)患者中的预后意义仍然未知。

近日,内分泌和代谢性疾病领域权威杂志Journal of Clinical Endocrinology & Metabolism上发表了一篇研究文章,研究人员将慢性肾脏功能不全队列(CRIC)参与者根据空腹血糖、HbA1c和在基线时使用抗糖尿病药物治疗分为正常血糖、糖尿病前期或糖尿病受试者。未经调整和调整的比例风险模型适合于估计糖尿病前期h和糖尿病(相对于血糖正常)与:1)复合肾结局(终末期肾脏疾病,估计肾小球滤过率下降50%至≤15ml/min/1.73m2,或尿蛋白与肌酐之比增加一倍至≥0.22g/g); 2)复合心血管(CV)结局(充血性心力衰竭、心肌梗塞或卒中)之间的相关性。

3701人进行分析,其中945人为血糖正常,847人为糖尿病前期,1909人为糖尿病患者。中位随访时间为7.5年。糖尿病前期与综合肾脏结局无关(经调整的风险比[aHR]为1.13,95%置信区间[CI] 0.96-1.32;P=0.14),但与蛋白尿进展有关(aHR为1.23,95%CI为1.03-1.47);P=0.02)。糖尿病前期与复合CV结局较高风险(aHR为1.38,95%CI为1.05-1.82; P=0.02)和全因死亡率趋势(aHR为1.28,95%CI为0.99-1.66; 0.07)相关。糖尿病患者的复合肾脏结局、复合心血管结局和全因死亡率风险增加。

在CKD患者中,糖尿病前期与复合肾结局无关,但与蛋白尿进展和CV不良风险增加有关。
 
原始出处:

João Sérgio Neves,et al.Association of prediabetes with CKD progression and adverse cardiovascular outcomes: an analysis of the CRIC study.J Clin Endocrinol Metab.2020.https://doi.org/10.1210/clinem/dgaa017

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    2020-05-28 smallant2015
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    2020-04-17 achengzhao
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    2020-01-18 misszhang

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