Background: Whether estimated glomerular filtration rates (eGFRs) by differing biomarkers are differentially associated with mortality or whether the associations differ by diabetes status remains unclear, especially in Chinese population.
Methods: We included 6995 participants without diabetes (mean age: 60.4 years) and 1543 with diabetes (mean age: 61.8 years). Each eGFR measure was divided into normal (≥90 mL/min/1.73 m2 ), modestly declined (60 to <90 mL/min/1.73 m2 ), and chronic kidney disease (CKD) (<60 mL/min/1.73 m2 ) groups. Cox proportional hazards models were used to estimate hazard ratio (HR) of all-cause mortality associated with each eGFR.
Results: Over a follow-up of 7 years, 677 and 215 deaths occurred among individuals without or with diabetes, respectively. Among those without diabetes, all measures of modestly declined eGFR were not associated with mortality, whereas CKD defined by eGFR cystatin C (eGFRcys) and eGFR creatinine (eGFRcr)-cys (HRs were 1.71 and 1.55, respectively) but not by eGFRcr were associated with higher risk of mortality. Among diabetes, all measures of modestly declined eGFR (HRs: 1.53, 1.56, and 2.09 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) and CKD (HRs: 2.57, 2.99, and 3.92 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) were associated with higher risk of mortality. Regardless of diabetes status, an addition of eGFRcys or eGFRcr-cys to traditional risk factors lead to a larger improvement in the prediction of all-cause mortality risk than adding eGFRcr.
Conclusions: The association of eGFR with mortality risk appeared to be varied by its measures and by diabetes status among middle-aged and older Chinese, which needs to be considered in clinical practice.
【摘要】 背景 通过不同生物标志物估计的肾小球滤过率(eGFRs)是否与死亡率不同相关，或者这种相关性是否因糖尿病状态而不同仍然不清楚，特别是在中国人群中。方法 本研究纳入了6 995名非糖尿病患者(平均年龄60.4岁)和1 543例糖尿病患者(平均年龄61.8岁)。每项eGFR测量分为正常[≥90 mL/min-1 ·(1.73 m2 )-1 ]、中度下降[ 60~90 mL/min-1 ·(1.73 m2 )-1 ]和慢性肾病(CKD) [ <60 mL/min-1 ·(1.73 m2 )-1 ]组。Cox比例风险模型用于估计与每种eGFR相关的全因死亡率的风险比(HR)。结果 在7年的随访中，非糖尿病患者有677人死亡，糖尿病患者有215人死亡。在非糖尿病的患者中，eGFR轻度下降的所有指标都与死亡率无关，而由eGFRcys和eGFRcr-cys定义的CKD(HR分别为1.71和1.55)，而不是由eGFRcr定义的CKD与较高的死亡风险相关。在糖尿病患者中，所有适度下降的eGFR(分别为eGFRcr、eGFRcys和eGFRcr-cys的HR 1.53、1.56和2.09)和CKD(分别为eGFRcr、eGFRcys和eGFRcr-cys的HR 2.57、2.99和3.92)与较高的死亡风险相关。无论糖尿病状态如何，在传统的危险因素中加入eGFRcys或eGFRcr-cys，比加入eGFRcr，在预测全因死亡风险方面有更大的改善。结论 在中国老年人群中，eGFR与死亡风险的关系似乎因其测量方法和糖尿病状况而异，这需要在临床实践中加以考虑。.
Keywords: all-cause mortality; chronic kidney disease; creatinine; cystatin C; diabetes; estimated glomerular filtration rate; 估计肾小球滤过率; 全因死亡率; 慢性肾病; 糖尿病; 肌酐; 胱抑素C.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.