Diabetologia:2型糖尿病中eGFR斜率与随后血管结局风险及全因死亡率的关系

2019-12-24 MedSci MedSci原创

研究结果支持eGFR斜率在2型糖尿病中作为肾脏结局的替代终点的效用,以及作为识别心血管疾病和全因死亡率高危个体的预后因素。

有研究报道,eGFR (eGFR斜率)的年度变化与终末期肾病、心血管疾病和一般死亡或慢性肾病患者的未来风险相关。然而,目前,使用eGFR斜率来预测糖尿病主要临床结果的益处还不清楚。

研究人员使用来自糖尿病血管疾病的作用的数据:PreteraxDiamicron MR对照评价(ADVANCE)试验和试验后观察研究(ADVANCE- on)。在排除最初由ACE抑制剂和利尿剂联合用药引起的eGFR急剧下降的前4个月后,通过线性混合模型对eGFR斜率进行了评估,在随机化后的41224个月使用了三种eGFR测量值 超过20个月,并根据四分位数进行分类。 使用Cox回归模型评估研究的主要结局,主要肾事件,主要大血管事件和全因死亡率的校正后的HR,这些结果在随机化后的24个月进行后续随访。

该队列共有8879名参与者(占80%),平均年龄为65.6岁(SD 6.3),平均eGFR75 ml min-11.73 m-2SD 17),中位尿白蛋白/肌酐比值为14μg/ mg(四分位数范围7-38 平均eGFR斜率是-0.63 ml min-11.73 m-2 year-1SD 1.75)。 在确定20个月eGFR斜率后的7.6年中位数随访中,有2,221名参与者(25%)达到了主要结局。 eGFR的年度大幅下降(最低25%,<-1.63 ml min-1 [1.73 m] -2 year-1)与随后的主要结局风险显著相关(HR 1.30 [95CI 1.171.43] )与eGFR的稳定变化(中值为50%,-1.630.33)相比。 eGFR的年度大幅增加(最高25%,> 0.33)与主要结局的风险没有显著相关性(HR 0.96 [95CI 0.861.07])。

研究结果支持eGFR斜率在2糖尿病中作为肾脏结局的替代终点的效用,以及作为识别心血管疾病和全因死亡率高危个体的预后因素。

原始出处:

Megumi OshimaMin JunThe relationship between eGFR slope and subsequent risk of vascular outcomes and all-cause mortality in type 2 diabetes: the ADVANCE-ON study

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    2019-12-26 liuyiping
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    2019-12-24 misszhang

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