根据联邦糖尿病登记册(2010-2022),俄罗斯联邦糖尿病患者慢性肾病流行病学趋势

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Diabetes Mellitus Pub Date : 2023-10-23 DOI:10.14341/dm13090
M. S. Shamkhalova, O. K. Vikulova, A. V. Zheleznyakova, M. A. Isakov, M. V. Shestakova, I. I. Dedov, N. G. Mokrysheva
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引用次数: 0

摘要

背景:糖尿病(DM)合并慢性肾脏疾病(CKD)是一个超病理学概念,其特征是多因素肾脏损害与心血管和死亡风险增加相关,这决定了该问题在糖尿病患者中的高度医学和社会意义。目的:根据联邦糖尿病登记册(FDR),评估2010-2022年俄罗斯联邦(RF) 1型(T1)和2型(T2)成年DM患者CKD的临床和流行病学特征,并介绍登记册分析工具评估器官保护治疗和预测病理风险的能力。材料和方法:我们使用了FRD数据库(http://diaregistry.ru), RF的85个区域。数据为2023年1月1日的动态数据,为2010-2022年的动态数据。结果:动态2010→2022年RF地区成年DM患者CKD患病率显示T1从21.5%增加到27.1%(1.3倍),T2从5.2增加到19.1%(3.7倍)。T1期CKD新发发病率为153.3→106.3/万成人患者,T2期为64.3→212.8/万成人患者。对CKD分期分布的分析有助于提高并发症的诊断。在2010年→2022年CKD新发病例的动态结构中。符合KDIGO标准的低、中度心血管事件合并终末期肾功能衰竭患者比例在T1组增加63.7→82.4%,在T2组增加64.5→77.4%。非常高危患者的比例在T1阶段逐渐下降12.3→4.0%,T2阶段为13.1→1.6%。1型和2型糖尿病患者CKD的平均发病年龄平均增加了6岁(分别为35.6→42岁,63.3→69.3岁),CKD发展时平均DM持续时间的动态变化:T1为11.5→14.8岁,T2为7.4→7.8岁。终末期CKD的病因在DM患者死亡结构中仅占T1患者的5.6%,占T2D患者的2.0%。对DM合并COVID-19患者致死性结局影响因素的回顾性分析显示,有CKD病史的T2DM患者死亡风险增加1.49倍(95% CI 1.01-2.04)。对T2DM患者和CKD降糖治疗结构的分析表明,与一般T2DM患者相比,SGLT-2抑制剂、DPP-4抑制剂和GLP-1受体拮抗剂组的药物处方更为频繁。FRD中有CKD预后计算器,它可以根据一组最重要的预测因素评估特定患者5年内发生病理的风险,其中包括6个T1因素和11个T2因素。结论:13年来CKD患病率的流行病学趋势表明,这一问题在处于危险中的DM患者中日益重要。随着糖尿病病程延长的病理发展的积极趋势,在临床实践中,CKD晚期肾功能受损的检测不及时的问题仍然存在。根据临床建议,病程的进行性和肾损害对患者过早死亡风险的负面影响决定了预防性诊断和治疗策略的优先级,这些策略旨在遵守检查标准,早期阶段的病理检测和多因素的肾保护方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)
BACKGROUND : Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients. AIMS : To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology. MATERIALS AND METHODS : We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022. RESULTS : The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a longer duration of diabetes, in clinical practice the problem remains of untimely detection of CKD with impaired renal function at advanced stages. The progressive nature of the course and the negative impact of kidney damage on the risks of premature mortality in patients determine the priority of preventive diagnostic and therapeutic strategies aimed at compliance with the standard of examination, detection of pathology in the early stages and a multifactorial approach to nephroprotection, according to clinical recommendations.
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来源期刊
Diabetes Mellitus
Diabetes Mellitus ENDOCRINOLOGY & METABOLISM-
CiteScore
1.90
自引率
40.00%
发文量
61
审稿时长
7 weeks
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