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Risk of cardiovascular disease, death, and renal progression in diabetes according to albuminuria and estimated glomerular filtration rate

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单位: [1]Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [2]Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [3]Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China [4]Qilu Hospital of Shandong University, Jinan, China [5]Jiangxi People’s Hospital, Nanchang, China [6]The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China [7]Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China [8]The Affiliated Hospital of Southwest Medical University, Luzhou, China [9]Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [10]Affiliated Hospital of Guiyang Medical College, Guiyang, China [11]Zhejiang Provincial Center for Disease Control and Prevention, China [12]The First Hospital of Lanzhou University, Lanzhou, China [13]Xinhua Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China [14]Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [15]The First Affiliated Hospital of Guangxi Medical University, Nanning, China [16]Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China [17]Dalian Municipal Central Hospital, Dalian, China [18]The First Hospital of Jilin University, Changchun, China [19]The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China [20]Central Hospital of Shanghai Jiading District, Shanghai, China [21]Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China [22]The First Affiliated Hospital of Anhui Medical University, Hefei, China [23]Karamay Municipal People’s Hospital, Xinjiang, China [24]The First Affiliated Hospital of Nanjing Medical University, Nanjing, China [25]The Second Affiliated Hospital of Harbin Medical University, Harbin, China [26]Chinese People’s Liberation Army General Hospital, Beijing, China [27]Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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关键词: Albuminuria Chronic kidney disease progression Diabetic kidney disease Glomerular filtration rate Major cardiovascular event Mortality

摘要:
We aimed to examine risks of major cardiovascular events (MACEs), renal outcomes, and all-cause mortality in type 2 diabetes mellitus (T2DM) patients with different diabetic kidney disease (DKD) subtypes.A total of 36,509 participants with T2DM recruited from 20 community sites across mainland China were followed up during 2011-2016. DKD subtypes were categorized based on albuminuria (urinary albumin-to-creatinine ratio, UACR ≥ 30 mg/g) and reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) as Alb-/eGFR-, Alb+/eGFR-, Alb-/eGFR+, and Alb+/eGFR+. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of developing clinical outcomes in DKD subtypes.More than half (53.5%) of participants with diabetes and reduced eGFR had normal UACR levels (Alb-/eGFR+), termed as non-albuminuria DKD. These patients had a modest increase in the risks of MACEs (hazard ratio, HR 1.42 [95% CI 1.08;1.88]) and mortality (HR 1.42 [1.04;1.92]) compared with patients without DKD, whereas CKD progression was not significantly increased (HR 0.97 [0.60;1.57]). Participants with albuminuria (Alb+/eGFR- or Alb+/eGFR+) had higher risks of clinical outcomes. Subgroup analysis revealed that the associations between non-albuminuria DKD and risks of MACEs and mortality were more evident in those aged <65 years.Non-albuminuria DKD accounts for more than half of DKD cases with low eGFR in Chinese diabetes patients. Diabetes patients with albuminuria are at higher risks of developing clinical outcomes and warrant early intervention, as well as patients with non-albuminuria DKD with age < 65 years.Copyright © 2023 Elsevier Masson SAS. All rights reserved.

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出版当年[2022]版:
大类 | 2 区 医学
小类 | 2 区 内分泌学与代谢
最新[2025]版:
大类 | 2 区 医学
小类 | 2 区 内分泌学与代谢
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出版当年[2021]版:
Q1 ENDOCRINOLOGY & METABOLISM
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Q1 ENDOCRINOLOGY & METABOLISM

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

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第一作者单位: [1]Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [2]Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [3]Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
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通讯机构: [1]Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [2]Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China [*1]Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, China
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