Frequency and sequence of proteinuria positivity and clinical outcomes in patients with diabetes: A nationwide cohort study.

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2025-04-04 DOI:10.1111/dom.16345

Junseok Jeon, Kyungho Lee, Jung Eun Lee, Wooseong Huh, Kyungdo Han, Hye Ryoun Jang

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Abstract

Aims: Proteinuria is a risk factor for end-stage kidney disease (ESKD) and cardiovascular disease (CVD) in patients with diabetes. However, the clinical implications of fluctuating proteinuria are unclear. We investigated the proteinuria burden and the risks of clinical outcomes in patients with diabetes using the Korean National Health Insurance Service database.

Materials and methods: This retrospective cohort study included patients with diabetes who participated in a national health screening between 2015 and 2016, with records of three previous health screenings. Each end-point was followed until 31 December 2022. The proteinuria burden (range: 0-4) was defined as the cumulative number of positive urine protein dipstick tests at each health screening. The outcomes included ESKD, CVD and all-cause mortality.

Results: Among 1 264 699 patients, 86.3%, 9.4%, 2.5%, 1.2% and 0.6% had proteinuria burdens of 0 to 4, respectively. The proteinuria burden and risks of clinical outcomes had dose-dependent associations; compared to proteinuria burden 0, the adjusted hazard ratio (95% confidence interval) of proteinuria burdens 1, 2, 3 and 4, respectively, were as follows: ESKD, 3.539 (3.326-3.766), 9.373 (8.816-9.965), 14.539 (13.652-15.484) and 19.704 (18.412-21.087); CVD, 1.247 (1.214-1.280), 1.530 (1.465-1.599), 1.815 (1.713-1.923) and 2.032 (1.883-2.192); and all-cause mortality, 1.335 (1.302-1.369), 1.703 (1.635-1.774), 1.959 (1.855-2.068) and 2.092 (1.945-2.250). Within the same proteinuria burdens, late-positive proteinuria was associated with worse outcomes than early-positive proteinuria.

Conclusions: The proteinuria burden was dose-dependently associated with clinical outcomes in patients with diabetes. Even a single positive dipstick test requires active management.

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糖尿病患者蛋白尿阳性的频率和序列与临床结果：一项全国性队列研究。

目的：蛋白尿是糖尿病患者终末期肾病（ESKD）和心血管疾病（CVD）的危险因素。然而，波动性蛋白尿的临床意义尚不清楚。我们使用韩国国民健康保险服务数据库调查了糖尿病患者的蛋白尿负担和临床结果的风险。材料与方法：本回顾性队列研究纳入了2015年至2016年参加全国健康筛查的糖尿病患者，并记录了此前的三次健康筛查。每个终点都被跟踪到2022年12月31日。蛋白尿负担（范围：0-4）定义为每次健康筛查中尿蛋白试纸试验阳性的累积次数。结果包括ESKD、CVD和全因死亡率。结果：1 264 699例患者中，蛋白尿负担0 ~ 4的比例分别为86.3%、9.4%、2.5%、1.2%和0.6%。蛋白尿负担与临床结局风险呈剂量依赖关系；与蛋白尿负担0相比，蛋白尿负担1、2、3、4的调整风险比（95%可信区间）分别为：ESKD为3.539（3.326 ~ 3.766）、9.373（8.816 ~ 9.965）、14.539（13.652 ~ 15.484）、19.704 (18.412 ~ 21.087)；心血管疾病,1.247(1.214 - -1.280),1.530(1.465 - -1.599),1.815(1.713 - -1.923)和2.032 (1.883 - -2.192);全因死亡率分别为1.335（1.302 ~ 1.369）、1.703（1.635 ~ 1.774）、1.959（1.855 ~ 2.068）、2.092（1.945 ~ 2.250）。在相同的蛋白尿负荷下，晚期阳性蛋白尿比早期阳性蛋白尿的预后更差。结论：糖尿病患者的蛋白尿负担与临床结果呈剂量依赖性。即使是一个阳性的油尺测试也需要积极的管理。

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

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.