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Risk Factors for Kidney Disease in Type 1 Diabetes

机译：1型糖尿病肾病的危险因素

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OBJECTIVE In type 1 diabetes (T1D), the course of microalbuminuria is unpredictable and timing of glomerular filtration rate (GFR) loss is uncertain. Thus, there is a need to identify the risk factors associated with the development of more advanced stages of kidney disease through large, long-term systematic analysis. RESEARCH DESIGN AND METHODS Multivariable Cox proportional hazards models assessed the association of baseline and time-dependent glycemic and nonglycemic risk factors for incident macroalbuminuria and reduced estimated GFR (eGFR; defined as <60 mL/min/1.73 m(2)) over a mean of 27 years in the Diabetes Control and Complications Trial (DCCT) cohort. RESULTS Higher mean HbA(1c) (hazard ratio [HR] 1.969 per 1% higher level [95% CI 1.671-2.319]) and male sex (HR 2.767 [95% CI 1.951-3.923]) were the most significant factors independently associated with incident macroalbuminuria, whereas higher mean triglycerides, higher pulse, higher systolic blood pressure (BP), longer diabetes duration, higher current HbA(1c), and lower mean weight had lower magnitude associations. For incident reduced eGFR, higher mean HbA(1c) (HR 1.952 per 1% higher level [95% CI 1.714-2.223]) followed by higher mean triglycerides, older age, and higher systolic BP were the most significant factors. CONCLUSIONS Although several risk factors associated with macroalbuminuria and reduced eGFR were identified, higher mean glycemic exposure was the strongest determinant of kidney disease among the modifiable risk factors. These findings may inform targeted clinical strategies for the frequency of screening, prevention, and treatment of kidney disease in T1D.
机译：目的在1型糖尿病（T1D）中，微白蛋白尿过程是不可预测的，并且肾小球过滤速率（GFR）损失的时间不确定。因此，需要通过大型长期系统分析识别与肾病更先进的阶段相关的危险因素。研究设计和方法多变量的Cox比例危害模型评估了基线和时间依赖性血糖和氮素肿瘤危险因素的结合，用于入射的大核蛋氨酸和减少的GFR（EGFR;定义为<60ml / min / 1.73 m（2））糖尿病控制和并发症试验（DCCT）队列27年。结果较高的平均HBA（1C）（危害比[HR]每1％更高水平[95％CI 1.671-2.319]）和男性性别（HR 2.767 [95％CI 1.951-3.923]）是最重要的因素独立关联与事件发生异常蛋氨酸，而平均甘油三酯，脉冲更高，收缩压较高（BP），较长的糖尿病持续时间，较高的电流HBA（1c），较低的平均重量具有较低的幅度关联。对于事件减少EGFR，更高的平均HBA（1C）（每1％的HR 1.952较高水平[95％CI 1.714-223]），然后是甘油三酯，年龄较大的年龄，更高的收缩压BP是最重要的因素。结论虽然鉴定了与大鼠和降低EGFR相关的几种危险因素，但血糖暴露的更高平均血糖暴露是可改善危险因素中肾病最强的决定因素。这些发现可以为T1D中肾脏疾病的筛选，预防和治疗频率提供促进临床策略。

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