2000年至2020年1型糖尿病合并糖尿病肾病的预后——随时间肾功能下降的变化以及心血管疾病、肾衰竭和死亡率的发展

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2024-12-01 DOI:10.1016/j.ekir.2024.09.010

Christina G. Poulsen , Kristin Jesse , Bendix Carstensen , Marie Frimodt-Møller , Tine W. Hansen , Frederik Persson , Dorte Vistisen , Peter Rossing

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引用次数: 0

摘要

1型糖尿病（T1D）和糖尿病肾病（DN）患者的肾功能进行性下降，心血管疾病（CVD）和死亡率高。本研究探讨了2000年至2020年间新发DN患者肾功能下降的变化，并提供了肾衰竭、心血管疾病和死亡率风险的最新预后。方法：这是一项基于登记的队列研究，在丹麦哥本哈根Steno糖尿病中心，2000年至2020年期间，对T1D合并新发DN（严重蛋白尿增加）进行研究。数据来源于电子健康记录和国家登记册。使用混合效应模型将肾功能发展表示为估计肾小球滤过率（eGFR）和测量GFR （mGFR）的轨迹。预后以并发症发生概率、性别、既往心血管疾病和危险因素控制为依据，通过泊松回归分析进行模拟。结果：该队列包括591名患者，DN发病年龄中位数（四分位间距[IQR]）为53（39-66）岁，其中57%为男性。283名参与者可获得mGFR。eGFR轨迹图显示了近年来eGFR升高的趋势；然而，这在mGFR轨迹中没有得到证实。不良的危险因素控制、既往心血管疾病和男性对死亡率和发病率有负相关影响。对于风险因素控制良好且无CVD病史的男性和女性，DN发病后的10年死亡率分别为28%和26%。对于在DN发病前有不良危险因素控制和心血管疾病的男性和女性，男女10年死亡率均为62%。结论：研究结果不支持T1D和DN的预后改善，强调迫切需要新的治疗方法。

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Prognosis for Type 1 Diabetes with Diabetic Nephropathy between 2000 and 2020 - Changes in Kidney Function Decline Over Time and Development of Cardiovascular Disease, Kidney Failure, and Mortality

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Prognosis for Type 1 Diabetes with Diabetic Nephropathy between 2000 and 2020 - Changes in Kidney Function Decline Over Time and Development of Cardiovascular Disease, Kidney Failure, and Mortality

Introduction

Individuals with type 1 diabetes (T1D) and diabetic nephropathy (DN) experience progressive kidney function decline and high risk of cardiovascular disease (CVD) and mortality. This study explored changes in kidney function decline in new-onset DN between 2000 and 2020 and provided an updated prognosis for risk of kidney failure, CVD, and mortality.

Methods

This is a register-based cohort study in T1D with new-onset DN (severely increased albuminuria) between 2000 and 2020 at Steno Diabetes Center Copenhagen, Denmark. Data were derived from electronic health records and national registers. Kidney function development was expressed as trajectories of estimated glomerular filtration rate (eGFR) and measured GFR (mGFR) using mixed-effects models. The prognosis was presented in probabilities of developing complications, stratified by sex, prior CVD, and risk factor control by using simulations based on Poisson regression analysis.

Results

The cohort comprised 591 individuals with median (interquartile range [IQR]) age at DN onset of 53 (39–66) years and 57% were male. In 283 participants, mGFR were available. Plots of eGFR trajectories illustrated tendencies toward higher eGFR in more recent years; however, this was not confirmed in mGFR trajectories. Poor risk factor control, prior CVD, and male sex impacted mortality and morbidity rates negatively. For men and women with fair risk factor control and no prior CVD, the 10-year mortality rate from onset of DN was 28% and 26%, respectively. For men and women with poor risk factor control and CVD prior to DN onset, the 10-year-mortality rate was 62% for each sex.

Conclusion

The results do not support an improved prognosis for T1D and DN, emphasizing the urgent need for new therapeutic approaches.

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.