在未发展为糖尿病的人中,糖尿病前期作为超滤和白蛋白尿的危险因素的作用尚不清楚。缺乏证据主要是由于难以准确评估肾小球滤过率(GFR)在接近正常范围的GFR。我们使用测量的GFR(mGFR)而不是估计的GFR,研究了糖尿病前期是否是肾小球超滤和高正常尿白蛋白-肌酐比值(ACR)的独立危险因素。
基于Tromsø6(RENIS-T6)肾脏碘海醇清除率调查和RENIS随访研究的前瞻性队列研究。中位观察时间为5.6年。
来自50至62岁的普通人群的1,261名没有糖尿病(DM)的人的代表性样本。
根据美国糖尿病协会(preDMADA)和2009年国际专家委员会(preDMIEC)建议的水平,由空腹血糖和血红蛋白A1c定义的糖尿病前期。
mGFR变化;超滤定义为mGFR>第90百分位数,根据年龄调整,性别,体重,和身高;随访时ACR正常较高(>10mg/g)。
用碘海醇清除率测量GFR。
基线空腹血糖,血红蛋白A1c,在多变量校正回归分析中,糖尿病前期的两种定义都是随访时mGFR较高和mGFR年下降较低的预测因子.在随访时,患有前DMIEC的参与者对超滤的OR为1.95(95%CI,1.20-3.17),对正常高ACR的OR为1.83(95%CI,1.04-3.22)。我们调整了心血管危险因素,包括基线时的动态血压以及基线和随访之间降压药物使用的变化。
只有中年白人患者参加。关于如何定义肾小球高滤过尚无共识。
我们的发现暗示了糖尿病前期在肾小球高滤过和白蛋白尿发展中的独立作用。糖尿病前期可能是早期治疗的目标,以预防慢性高血糖中的慢性肾脏疾病。
The role of prediabetes as a risk factor for hyperfiltration and albuminuria in persons who do not develop diabetes is unclear. The lack of evidence is mainly due to the difficulty of accurately assessing the glomerular filtration rate (GFR) in the near-normal range of GFR. We investigated whether prediabetes is an independent risk factor for glomerular hyperfiltration and high-normal urinary albumin-creatinine ratio (ACR) using measured GFR (mGFR) rather than estimated GFR.
Prospective cohort
study based on the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6) and the RENIS Follow-Up
Study. Median observation time was 5.6 years.
A representative sample of 1,261 persons without diabetes mellitus (DM) from the general population aged 50 to 62 years.
Prediabetes defined by fasting glucose and hemoglobin A1c according to levels suggested by the American Diabetes Association (preDMADA) and the International Expert Committee of 2009 (preDMIEC).
Change in mGFR; hyperfiltration defined as mGFR>90th percentile adjusted for age, sex, weight, and height; and high-normal ACR (>10mg/g) at follow-up.
GFR was measured with iohexol clearance.
Baseline fasting glucose, hemoglobin A1c, and both definitions of prediabetes were predictors of higher mGFR at follow-up and lower annual mGFR decline in multivariable-adjusted regression analyses. Participants with preDMIEC had an OR for hyperfiltration of 1.95 (95% CI, 1.20-3.17) and for high-normal ACR of 1.83 (95% CI, 1.04-3.22) at follow-up. We adjusted for cardiovascular risk factors including ambulatory blood pressure at baseline and change in use of antihypertensive medication between baseline and follow-up.
Only middle-aged white patients participated. There is no consensus on how to define glomerular hyperfiltration.
Our findings imply an independent role of prediabetes in the development of glomerular hyperfiltration and albuminuria. Prediabetes might be a target for early treatment to prevent chronic kidney disease in chronic hyperglycemia.