Association of Albuminuria Within the Normoalbuminuric Range With All-Cause Mortality in People With Type 2 Diabetes

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews Pub Date : 2025-06-25 DOI:10.1002/dmrr.70061

Monia Garofolo, Giuseppe Penno, Anna Solini, Emanuela Orsi, Martina Vitale, Veronica Resi, Enzo Bonora, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Antonio Nicolucci, Giuseppe Pugliese, Renal Insufficiency And Cariovascular Events (RIACE) Study Group

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Abstract

Aims

To investigate the independent association of albuminuria within the normoalbuminuric range with all-cause mortality in normoalbuminuric people with type 2 diabetes with and without chronic kidney disease (CKD).

Materials and Methods

This observational, prospective, multicentre, cohort study enroled 15,773 individuals with type 2 diabetes in 2006–2008. At baseline, albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR) were assessed together with cardiometabolic risk profile, treatments, complications, and comorbidities. All-cause mortality was verified on 31 October 2015.

Results

Of the 15,656 participants (99.3%) with valid information on vital status, 11,460 (71.2%) were normoalbuminuric, 9984 (87.1%) without and 1476 (12.9%) with CKD. Normoalbuminuric individuals were stratified into three (< 5, 5–15, and > 15 mg·day⁻¹) or two (< 10 and 10–29 mg·day⁻¹) AER subcategories. When adjusting for age, sex, eGFR, prior cardiovascular disease, cardiovascular risk factors, and treatments, mortality risk was higher in participants with AER 10–29 versus < 10 mg·day⁻¹ (hazard ratio, 1.120 [95% confidence interval, 1.028–1.221], p = 0.009) and 15–29 versus < 5 mg·day⁻¹ (1.243 [1.099–1.406], p < 0.0001). When stratifying by CKD status, the adjusted risk remained significantly increased only for AER 15–29 versus < 5 mg/24 h in individuals with (1.404 [1.111–1.774], p = 0.005) and, to a lesser extent, without (1.167 [1.009–1.350], p = 0.038) CKD. A non-linear association was observed between AER as Log2 transformed continuous variable and mortality.

Conclusions

For the same level of kidney function, higher AER within the normoalbuminuric range was independently associated with all-cause mortality, thus supporting to the use of albuminuria-lowering drugs in people with type 2 diabetes and mildly elevated albuminuria.

Trial Registration

ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

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2型糖尿病患者蛋白尿正常范围内与全因死亡率的关系

目的探讨2型糖尿病伴或不伴慢性肾脏疾病（CKD）的蛋白尿正常范围内与全因死亡率之间的独立关系。这项观察性、前瞻性、多中心、队列研究在2006-2008年间纳入了15773例2型糖尿病患者。基线时，白蛋白排泄率（AER）和估计肾小球滤过率（eGFR）与心脏代谢风险概况、治疗、并发症和合并症一起评估。2015年10月31日核实了全因死亡率。结果：15656名参与者（99.3%）具有有效的生命状态信息，11460名（71.2%）蛋白尿正常，9984名（87.1%）无CKD， 1476名（12.9%）患有CKD。正常蛋白尿者分为三组(<；5、5 - 15和>；15mg·天−1)或两次(<；10和10 - 29 mg·天−1)AER亚类。在调整年龄、性别、eGFR、既往心血管疾病、心血管危险因素和治疗后，AER 10-29患者的死亡风险高于AER 10-29患者。10 mg·day−1（风险比，1.120[95%可信区间，1.028-1.221],p = 0.009）和15-29对<；5 mg·day−1 (1.243 [1.099-1.406],p <；0.0001)。当按CKD状态分层时，调整后的风险仅在AER 15-29与<；CKD患者（1.404 [1.111-1.774],p = 0.005）和非CKD患者（1.167 [1.009-1.350],p = 0.038）的5mg /24 h。AER作为Log2转换后的连续变量与死亡率呈非线性相关。结论在相同肾功能水平下，正常蛋白尿范围内较高的AER与全因死亡率独立相关，因此支持2型糖尿病伴轻度蛋白尿升高患者使用降蛋白尿药物。临床试验注册：ClinicalTrials.gov, NCT00715481，回顾性注册，2008年7月15日。

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

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