Tapio A. Hellman , Ole-Christian Skare , Christopher Lee , Uta Wagner , Johanna Vikkula , Jenni Hällfors , Outi Laatikainen , Mariann I. Lassenius , Kaj Metsärinne
{"title":"芬兰2型糖尿病患者肾脏状况的心血管预后","authors":"Tapio A. Hellman , Ole-Christian Skare , Christopher Lee , Uta Wagner , Johanna Vikkula , Jenni Hällfors , Outi Laatikainen , Mariann I. Lassenius , Kaj Metsärinne","doi":"10.1016/j.deman.2022.100103","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><strong>:</strong> Type 2 diabetes (T2DM) increases the risk for chronic kidney disease (CKD). The objective of this study was to describe the characteristics of patients with T2DM and assess their cardiovascular (CV) and renal outcomes as well as survival in a real-life setting in Finland. The study aimed to map the use of diagnostic and monitoring measures in the management of T2DM patients in clinical practice and to assess the proportion of patients that could benefit from SGLT2 inhibitor treatment.</p></div><div><h3>Methods</h3><p><strong>:</strong> This retrospective registry study included 29,628 adult T2DM patients gathered from national registries in Finland between 2012 and 2018. Patients were included from primary and specialized care. From all patients, all available health care data, including laboratory results, degree of albuminuria, and eGFR data, was gathered. The occurrence of CV events and end-stage kidney disease (ESKD) was assessed using a multivariable Cox proportional hazards model. All-cause and CV deaths were visualized using Kaplan-Meier plots.</p></div><div><h3>Results</h3><p><strong>:</strong> Overall, patients were more frequently male (54%), and their mean age was 66 (SD = ±12.4) years. eGFR status was available for 21,889 patients, and among these patients CKD stage 3–5 was observed in 3,945 (13.3%) patients. Data on albuminuria was available in less than half (45.5%) of the cohort. In patients with available urinary albumin measurement, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria. Of all comorbidities, atrial fibrillation was independently associated with the risk of CV events and ESKD.</p></div><div><h3>Conclusions</h3><p><strong>:</strong> This large real-world study confirms that CV morbidity and mortality are substantial within T2DM patients, and that age, prior kidney function, albuminuria and prior diagnosis of AF were associated with the risk of CV events, including death, and progression to ESKD. Despite guideline recommendations, monitoring and treatment of T2DM was suboptimal leaving patients at risk of inadequate treatment.</p></div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666970622000531/pdfft?md5=37b32b4f344a3c1dc469e934d1c0565f&pid=1-s2.0-S2666970622000531-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Cardiovascular outcome according to renal status in Finnish patients with type 2 diabetes\",\"authors\":\"Tapio A. Hellman , Ole-Christian Skare , Christopher Lee , Uta Wagner , Johanna Vikkula , Jenni Hällfors , Outi Laatikainen , Mariann I. Lassenius , Kaj Metsärinne\",\"doi\":\"10.1016/j.deman.2022.100103\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><strong>:</strong> Type 2 diabetes (T2DM) increases the risk for chronic kidney disease (CKD). The objective of this study was to describe the characteristics of patients with T2DM and assess their cardiovascular (CV) and renal outcomes as well as survival in a real-life setting in Finland. The study aimed to map the use of diagnostic and monitoring measures in the management of T2DM patients in clinical practice and to assess the proportion of patients that could benefit from SGLT2 inhibitor treatment.</p></div><div><h3>Methods</h3><p><strong>:</strong> This retrospective registry study included 29,628 adult T2DM patients gathered from national registries in Finland between 2012 and 2018. Patients were included from primary and specialized care. From all patients, all available health care data, including laboratory results, degree of albuminuria, and eGFR data, was gathered. The occurrence of CV events and end-stage kidney disease (ESKD) was assessed using a multivariable Cox proportional hazards model. All-cause and CV deaths were visualized using Kaplan-Meier plots.</p></div><div><h3>Results</h3><p><strong>:</strong> Overall, patients were more frequently male (54%), and their mean age was 66 (SD = ±12.4) years. eGFR status was available for 21,889 patients, and among these patients CKD stage 3–5 was observed in 3,945 (13.3%) patients. Data on albuminuria was available in less than half (45.5%) of the cohort. In patients with available urinary albumin measurement, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria. Of all comorbidities, atrial fibrillation was independently associated with the risk of CV events and ESKD.</p></div><div><h3>Conclusions</h3><p><strong>:</strong> This large real-world study confirms that CV morbidity and mortality are substantial within T2DM patients, and that age, prior kidney function, albuminuria and prior diagnosis of AF were associated with the risk of CV events, including death, and progression to ESKD. 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Cardiovascular outcome according to renal status in Finnish patients with type 2 diabetes
Background
: Type 2 diabetes (T2DM) increases the risk for chronic kidney disease (CKD). The objective of this study was to describe the characteristics of patients with T2DM and assess their cardiovascular (CV) and renal outcomes as well as survival in a real-life setting in Finland. The study aimed to map the use of diagnostic and monitoring measures in the management of T2DM patients in clinical practice and to assess the proportion of patients that could benefit from SGLT2 inhibitor treatment.
Methods
: This retrospective registry study included 29,628 adult T2DM patients gathered from national registries in Finland between 2012 and 2018. Patients were included from primary and specialized care. From all patients, all available health care data, including laboratory results, degree of albuminuria, and eGFR data, was gathered. The occurrence of CV events and end-stage kidney disease (ESKD) was assessed using a multivariable Cox proportional hazards model. All-cause and CV deaths were visualized using Kaplan-Meier plots.
Results
: Overall, patients were more frequently male (54%), and their mean age was 66 (SD = ±12.4) years. eGFR status was available for 21,889 patients, and among these patients CKD stage 3–5 was observed in 3,945 (13.3%) patients. Data on albuminuria was available in less than half (45.5%) of the cohort. In patients with available urinary albumin measurement, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria. Of all comorbidities, atrial fibrillation was independently associated with the risk of CV events and ESKD.
Conclusions
: This large real-world study confirms that CV morbidity and mortality are substantial within T2DM patients, and that age, prior kidney function, albuminuria and prior diagnosis of AF were associated with the risk of CV events, including death, and progression to ESKD. Despite guideline recommendations, monitoring and treatment of T2DM was suboptimal leaving patients at risk of inadequate treatment.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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