Variability in HbA1c, blood pressure, lipid parameters and serum uric acid, and risk of development of chronic kidney disease in type 2 diabetes. in Diabetes, obesity & metabolism / Diabetes Obes Metab. 2017 Nov;19(11):1570-1578. doi: 10.1111/dom.12976. Epub 2017 Jul 10.
2017
ASL Torino 5
Tipo pubblicazione
Journal Article
Autori/Collaboratori (12)Vedi tutti...
Ceriello A
Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
De Cosmo S
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
Rossi MC
Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni (MI), Italy.
et alii...
Abstract
AIM: Variability in HbA1c and blood pressure is associated with the risk of diabetic kidney disease (DKD). No evidence exists on the role of variability in lipids or serum uric acid (UA), or the interplay between the variability of different parameters, in renal outcomes. METHODS: Within the AMD Annals database, we identified patients with ?5 measurements of HbA1c, systolic blood pressure (SBP) and diastolic blood pressure (DBP), total-, high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol, triglycerides, and UA. Patients were followed-up for up to 5?years. The impact of measures of variability on the risk of DKD was investigated by Cox regression analysis and recursive partitioning techniques. RESULTS: Four-thousand, two-hundred and thirty-one patients were evaluated for development of albuminuria, and 7560 for decreased estimated glomerular filtration rate (eGFR; <60?mL/min/1.73?m(2) ). A significantly higher risk of developing albuminuria was associated with variability in HbA1c [upper quartile hazard ratio (HR)?=?1.3; 95% confidence interval (CI) 1.1-1.6]. Variability in SBP, DBP, HDL-C, LDL-C and UA predicted the decline in eGFR, the association with UA variability being particularly strong (upper quartile HR?=?1.8; 95% CI 1.3-2.4). The concomitance of high variability in HbA1c and HDL-C conferred the highest risk of developing albuminuria (HR?=?1.47; 95% CI 1.17-1.84), while a high variability in UA (HR?=?1.54; 95% CI 1.19-1.99) or DBP (HR?=?1.47; 95% CI 1.11-1.94) conferred the
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PMID : 28432733
DOI : 10.1111/dom.12976
Keywords
chronic kidney failure; cholesterol blood level; article; blood pressure variability; albuminuria; age; aged; uric acid; adult; triacylglycerol; sulfonylurea; metformin; low density lipoprotein cholesterol; lipid; insulin; hemoglobin A1c; high density lipoprotein cholesterol; dipeptidyl peptidase IV inhibitor; dipeptidyl carboxypeptidase inhibitor; angiotensin receptor antagonist; cohort analysis; controlled study; diabetic nephropathy; diastolic blood pressure; disease duration; drug use; estimated glomerular filtration rate; female; follow up; gender; high risk patient; human; hypertension; intermediate risk patient; kidney function; lipid blood level; longitudinal study; major clinical study; male; non insulin dependent diabetes mellitus; observational study; risk factor; systolic blood pressure; triacylglycerol blood level; uric acid blood level;