Samy Hadjadj , Pierre Jean Saulnier , Bertrand Cariou , SURDIAGENE study investigators
{"title":"肾脏受累的严重程度作为2型糖尿病患者死亡、严重心力衰竭和肾脏事件的预测因素：来自前瞻性队列的数据。","authors":"Samy Hadjadj , Pierre Jean Saulnier , Bertrand Cariou , SURDIAGENE study investigators","doi":"10.1016/j.lpm.2023.104177","DOIUrl":null,"url":null,"abstract":"<div><p>Type 2 diabetes is associated with an increased risk for end-stage renal disease and heart failure, contributing to premature death. All these 3 events are inter-related, suggesting common risk factors and/or pathophysiological pathways.</p><p>The SURDIAGENE (SUrvie Rénale DIAbète et GENEtique) cohort is a single centre hospital-based cohort of persons living with type 2 diabetes, recruiting participants at Poitiers university hospital, France, from 2002 to 2011 with further follow-up till 2015.</p><p>Here, we describe the cumulative prevalence of hard renal events (sustained doubling of serum creatinine and/or renal replacement therapy), heart failure leading to hospitalization (HFH) and all-cause death, according to the KDIGO classification, which considers CKD stages according to CKD EPI equation <span>[1]</span>, <span>[2]</span>, <span>[3]</span>, <span>[4]</span>, <span>[5]</span> and albuminuria (A1, A2, A3) according to albumin/creatinine ratio with thresholds at 30 and 300 mg/g. We considered 1450 participants with KDIGO stage available at baseline.</p><p>Considering a cumulated follow-up duration of 10667 patient.years with 100 renal events, 247 HFH and 527 deaths, our study showed that the more severe the KDIGO stage, the higher the incidence rate not only for renal event, but also for HFH and for all-cause death. For instance, in CKD1A1 and CKD4A3 the incidence rates for hard renal events, HFH and death were 0.98 and 140.70, 4.46 and 107.09, 13.64 and 156.56 per 1000 patient.years, respectively. Interestingly, the incidence of renal event was lower than the incidence of all-cause death in all KDIGO stages, at variance with the data from recent renal outcome trials on SGLT2 inhibitors and finerenone.</p><p>We conclude that KDIGO stages should be considered for renal but also for HFH risk classification. The analysis of the respective incidence of renal events and deaths in observational studies and RCTs deserves further evaluation in type 2 diabetes.</p></div>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Severity of kidney involvement as predictor of death, severe heart failure and renal events in patients with type 2 diabetes: data from a prospective cohort\",\"authors\":\"Samy Hadjadj , Pierre Jean Saulnier , Bertrand Cariou , SURDIAGENE study investigators\",\"doi\":\"10.1016/j.lpm.2023.104177\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Type 2 diabetes is associated with an increased risk for end-stage renal disease and heart failure, contributing to premature death. All these 3 events are inter-related, suggesting common risk factors and/or pathophysiological pathways.</p><p>The SURDIAGENE (SUrvie Rénale DIAbète et GENEtique) cohort is a single centre hospital-based cohort of persons living with type 2 diabetes, recruiting participants at Poitiers university hospital, France, from 2002 to 2011 with further follow-up till 2015.</p><p>Here, we describe the cumulative prevalence of hard renal events (sustained doubling of serum creatinine and/or renal replacement therapy), heart failure leading to hospitalization (HFH) and all-cause death, according to the KDIGO classification, which considers CKD stages according to CKD EPI equation <span>[1]</span>, <span>[2]</span>, <span>[3]</span>, <span>[4]</span>, <span>[5]</span> and albuminuria (A1, A2, A3) according to albumin/creatinine ratio with thresholds at 30 and 300 mg/g. We considered 1450 participants with KDIGO stage available at baseline.</p><p>Considering a cumulated follow-up duration of 10667 patient.years with 100 renal events, 247 HFH and 527 deaths, our study showed that the more severe the KDIGO stage, the higher the incidence rate not only for renal event, but also for HFH and for all-cause death. For instance, in CKD1A1 and CKD4A3 the incidence rates for hard renal events, HFH and death were 0.98 and 140.70, 4.46 and 107.09, 13.64 and 156.56 per 1000 patient.years, respectively. Interestingly, the incidence of renal event was lower than the incidence of all-cause death in all KDIGO stages, at variance with the data from recent renal outcome trials on SGLT2 inhibitors and finerenone.</p><p>We conclude that KDIGO stages should be considered for renal but also for HFH risk classification. 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引用次数: 1
摘要
2型糖尿病与终末期肾病和心力衰竭的风险增加有关，导致过早死亡。所有这3个事件都是相互关联的，提示共同的危险因素和/或病理生理途径。SURDIAGENE（SUrvie Rénale DIAbète et GENEtique）队列是一个以2型糖尿病患者为基础的单中心医院队列，从2002年到2011年在法国普瓦捷大学医院招募参与者，并进一步随访到2015年。在这里，我们描述了根据KDIGO分类的硬肾事件（血清肌酐持续翻倍和/或肾脏替代治疗）、导致住院的心力衰竭（HFH）和全因死亡的累积患病率，根据CKD EPI方程[1-5]考虑CKD分期，根据白蛋白/肌酐比值考虑白蛋白尿（A1、A2、A3），阈值为30和300mg/g。我们在基线时考虑了1450名KDIGO阶段的参与者。考虑到10667名患者的累计随访时间，100例肾事件、247例HFH和527例死亡，我们的研究表明，KDIGO阶段越严重，不仅肾事件的发生率越高，HFH和全因死亡的发生率也越高。例如，在CKD1A1和CKD4A3中，硬肾事件、HFH和死亡的发生率分别为0.98和140.70、4.46和107.09、13.64和156.56/1000名患者年。有趣的是，在所有KDIGO阶段，肾事件的发生率都低于全因死亡的发生率，这与最近SGLT2抑制剂和芬瑞酮的肾结果试验数据不一致。我们得出的结论是，肾脏和HFH风险分类应考虑KDIGO分期。在2型糖尿病的观察性研究和随机对照试验中对肾脏事件和死亡的各自发生率的分析值得进一步评估。
Severity of kidney involvement as predictor of death, severe heart failure and renal events in patients with type 2 diabetes: data from a prospective cohort
Type 2 diabetes is associated with an increased risk for end-stage renal disease and heart failure, contributing to premature death. All these 3 events are inter-related, suggesting common risk factors and/or pathophysiological pathways.
The SURDIAGENE (SUrvie Rénale DIAbète et GENEtique) cohort is a single centre hospital-based cohort of persons living with type 2 diabetes, recruiting participants at Poitiers university hospital, France, from 2002 to 2011 with further follow-up till 2015.
Here, we describe the cumulative prevalence of hard renal events (sustained doubling of serum creatinine and/or renal replacement therapy), heart failure leading to hospitalization (HFH) and all-cause death, according to the KDIGO classification, which considers CKD stages according to CKD EPI equation [1], [2], [3], [4], [5] and albuminuria (A1, A2, A3) according to albumin/creatinine ratio with thresholds at 30 and 300 mg/g. We considered 1450 participants with KDIGO stage available at baseline.
Considering a cumulated follow-up duration of 10667 patient.years with 100 renal events, 247 HFH and 527 deaths, our study showed that the more severe the KDIGO stage, the higher the incidence rate not only for renal event, but also for HFH and for all-cause death. For instance, in CKD1A1 and CKD4A3 the incidence rates for hard renal events, HFH and death were 0.98 and 140.70, 4.46 and 107.09, 13.64 and 156.56 per 1000 patient.years, respectively. Interestingly, the incidence of renal event was lower than the incidence of all-cause death in all KDIGO stages, at variance with the data from recent renal outcome trials on SGLT2 inhibitors and finerenone.
We conclude that KDIGO stages should be considered for renal but also for HFH risk classification. The analysis of the respective incidence of renal events and deaths in observational studies and RCTs deserves further evaluation in type 2 diabetes.
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