Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

作者：Jin, Qiao; Luk, Andrea O.; Lau, Eric S. H.; Tam, Claudia H. T.; Ozaki, Risa; Lim, Cadmon K. P.; Wu, Hongjiang; Jiang, Guozhi; Chow, Elaine Y. K.; Ng, Jack K.; Kong, Alice P. S.; Fan, Baoqi; Lee, Ka Fai; Siu, Shing Chung; Hui, Grace; Tsang, Chiu Chi; Lau, Kam Piu; Leung, Jenny Y.; Tsang, Man-wo; Kam, Grace; Lau, Ip Tim; Li, June K.; Yeung, Vincent T.; Lau, Emmy; Lo, Stanley; Fung, Samuel; Cheng, Yuk Lun; Chow, Chun Chung; Huang, Yu; Lan, Hui-yao; Szeto, Cheuk Chun; So, Wing Yee

来源：American Journal of Kidney Diseases, 2022, 80(2): 196-+.

DOI：10.1053/j.ajkd.2021.11.011

• GLOMERULAR-FILTRATION-RATE
• STAGE RENAL-DISEASE
• ALBUMINURIA
• ADULTS
• INSUFFICIENCY
• DYSFUNCTION
• IMPAIRMENT
• PREDICTION
• EQUATIONS
• FAILURE

Rationale & Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes.Study Design: Multicenter prospective cohort study.Settings & Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank.Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR.Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction >= 40%).Analytical Approach: Multivariable Cox propor-tional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates.Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.4 4]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.4 8]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m2 yielded similar findings.Limitations: Potential misclassification because of drug use.Conclusions: Nonalbuminuric DKD was associ-ated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.

• 单位
  上海交通大学; 中山大学