Changes in urine dipstick proteinuria and its relation to the risk of diabetic retinopathy and neuropathy.

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2024-11-01 Epub Date: 2024-06-21 DOI:10.1007/s12020-024-03928-8

Sung Keun Park, Ju Young Jung, Min-Ho Kim, Chang-Mo Oh, Soonsu Shin, Eunhee Ha, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo

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Abstract

Background: Proteinuria is considered as a predictor for cardiovascular complications in diabetes mellitus (DM). However, no study has examined the association between changes in proteinuria and the risk of diabetic microvascular complications.

Methods: Study participants were 71,825 DM patients who received urine dipstick test for proteinuria both in 2003-2004 and 2006-2007. They were categorized into four groups according to changes in proteinuria over 3 years (negative: negative → negative, resolved: proteinuria ≥ 1+ → negative, incident: negative → proteinuria ≥ 1+, persistent: proteinuria ≥ 1+ → proteinuria ≥ 1+). Cox-proportional hazard model was used in assessing the adjusted hazard ratios (HR) and 95% confidence interval (CI) for incidence of retinopathy, and neuropathy (adjusted HR [95% CI]).

Result: In all of DM patients, risk for comprehensive incidence of retinopathy and neuropathy increased in all types of proteinuria changes. In type 1 DM, HR for retinopathy and neuropathy generally increased in order of negative (reference), resolved (2.175 [1.150-4.114] and 1.335 [0.909-1.961]), incident (2.088 [1.185-3.680] and 1.753 [1.275-2.409]), and persistent proteinuria (1.314 [0.418-4.134] and 2.098 [1.274-3.455]). This pattern of relationship was similarly observed in type 2 DM for retinopathy and neuropathy: negative (reference), resolved (1.490 [1.082-2.051] and 1.164 [0.988-1.371]), incident (1.570 [1.161-2.123] and 1.291 [1.112-1.500]), and persistent proteinuria (2.309 [1.407-3.788] and 1.272 [0.945-1.712]).

Conclusion: Risk for diabetic retinopathy and neuropathy generally increased in order of negative, resolved, incident, and persistent proteinuria. Once manifested proteinuria was associated with the increased risk of diabetic retinopathy and neuropathy even after remission of proteinuria.

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尿液量表蛋白尿的变化及其与糖尿病视网膜病变和神经病变风险的关系。

背景：蛋白尿被认为是糖尿病（DM）心血管并发症的预测因子。然而，目前还没有研究探讨蛋白尿的变化与糖尿病微血管并发症风险之间的关系：研究对象为 71825 名糖尿病患者，他们在 2003-2004 年和 2006-2007 年均接受了尿液定量检测。根据3年中蛋白尿的变化将他们分为4组（阴性：阴性→阴性；缓解：蛋白尿≥1+→阴性；事件：阴性→蛋白尿≥1+；持续：蛋白尿≥1+→蛋白尿≥1+）。采用 Cox 比例危险模型评估视网膜病变和神经病变发生率的调整危险比（HR）和 95% 置信区间（CI）：结果：在所有DM患者中，视网膜病变和神经病变的综合发病风险在所有蛋白尿变化类型中均有所增加。在 1 型 DM 中，视网膜病变和神经病变的 HR 一般依次为阴性（参考值）、缓解型（2.175 [1.150-4.114] 和 1.335 [0.909-1.961]）、事件型（2.088 [1.185-3.680] 和 1.753 [1.275-2.409]）和持续蛋白尿型（1.314 [0.418-4.134] 和 2.098 [1.274-3.455]）。在 2 型糖尿病视网膜病变和神经病变中也观察到类似的关系模式：阴性（参考值）、缓解（1.490 [1.082-2.051] 和 1.164 [0.988-1.371]）、偶发（1.570 [1.161-2.123] 和 1.291 [1.112-1.500]）和持续蛋白尿（2.309 [1.407-3.788] 和 1.272 [0.945-1.712]）：糖尿病视网膜病变和神经病变的风险一般按照蛋白尿阴性、缓解、偶发和持续的顺序增加。一旦出现蛋白尿，即使在蛋白尿缓解后，发生糖尿病视网膜病变和神经病变的风险也会增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.