中国成年人的糖尿病和慢性肾病:一项基于人群的队列研究。

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-01-24 DOI:10.1136/bmjdrc-2023-003721
Xue Wang, Lu Chen, Kexiang Shi, Jun Lv, Dianjianyi Sun, Pei Pei, Ling Yang, Yiping Chen, Huaidong Du, Jiaqiu Liu, Xiaoming Yang, Maxim Barnard, Junshi Chen, Zhengming Chen, Liming Li, Canqing Yu
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引用次数: 0

摘要

导言:糖尿病(DM)与慢性肾脏病(CKD)相关性的队列研究证据有限。以往的研究通常将肾病合并糖尿病的患者描述为糖尿病肾病(DKD)或慢性肾脏病(CKD),而忽略了其他亚型。本研究旨在评估中国成年人中糖尿病状态(无糖尿病、糖尿病前期、筛查出的糖尿病、既往诊断为控制/未控制糖尿病且接受/未接受抗糖尿病治疗)和随机血浆葡萄糖(RPG)与CKD风险(包括CKD亚型)的前瞻性关联:本研究纳入了来自中国嘉道理生物库的472 545名参与者,使用了糖尿病和随机血浆葡萄糖的基线信息。在随访过程中,通过与国家医疗保险系统的连接,收集事件性 CKD 及其亚型。采用 Cox 回归模型计算 HR 和 95% CI:结果:在平均 11.8 年的随访期间,有 5417 名成年人患上了慢性肾脏病。筛查和既往诊断的糖尿病与 CKD(HR=4.52,95% CI 4.23 至 4.83)、DKD(HR=33.85,95% CI 29.56 至 38.76)和肾小球肾炎(HR=1.66,95% CI 1.40 至 1.97)呈正相关。在既往确诊的糖尿病患者中,未控制的糖尿病患者与控制的RPG患者相比,患慢性肾脏病、慢性肾小球疾病和肾小球肾炎的风险更高。研究发现,糖尿病前期患者患 DKD 的风险上升,并且随着 RPG 水平的升高而增加,即使没有糖尿病的患者也是如此:结论:在中国成年人中,糖尿病与慢性肾脏病、慢性肾脏病和肾小球肾炎呈正相关。筛查发现和未控制的糖尿病患者罹患慢性肾小球肾炎的风险很高,而糖尿病前期患者罹患慢性肾小球肾炎的风险更高,这凸显了终身血糖管理的重要性。
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Diabetes and chronic kidney disease in Chinese adults: a population-based cohort study.

Introduction: Cohort evidence of the association of diabetes mellitus (DM) with chronic kidney disease (CKD) is limited. Previous studies often describe patients with kidney disease and diabetes as diabetic kidney disease (DKD) or CKD, ignoring other subtypes. The present study aimed to assess the prospective association of diabetes status (no diabetes, pre-diabetes, screened diabetes, previously diagnosed controlled/uncontrolled diabetes with/without antidiabetic treatment) and random plasma glucose (RPG) with CKD risk (including CKD subtypes) among Chinese adults.

Research design and methods: The present study included 472 545 participants from the China Kadoorie Biobank, using baseline information on diabetes and RPG. The incident CKD and its subtypes were collected through linkage with the national health insurance system during follow-up. Cox regression models were used to calculate the HR and 95% CI.

Results: During 11.8 years of mean follow-up, 5417 adults developed CKD. Screened plus previously diagnosed diabetes was positively associated with CKD (HR=4.52, 95% CI 4.23 to 4.83), DKD (HR=33.85, 95% CI 29.56 to 38.76), and glomerulonephritis (HR=1.66, 95% CI 1.40 to 1.97). In those with previously diagnosed diabetes, participants with uncontrolled diabetes represented higher risks of CKD, DKD, and glomerulonephritis compared with those with controlled RPG. The risk of DKD was found to rise in participants with pre-diabetes and increased with the elevated RPG level, even in those without diabetes.

Conclusions: Among Chinese adults, diabetes was positively associated with CKD, DKD, and glomerulonephritis. Screen-detected and uncontrolled DM had a high risk of CKD, and pre-diabetes was associated with a greater risk of DKD, highlighting the significance of lifelong glycemic management.

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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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