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Diabetes Care:注意了!2型糖尿病患者的肾脏功能检测远不达标!

2021-09-25 MedSci原创 MedSci原创

对于T2DM患者,美国糖尿病协会(ADA)建议至少每年检测eGFR和uACR。

每九个成年人中就有一个患有2型糖尿病(T2DM),其中三分之一的人还患有慢性肾脏病(CKD),指的是肾小球滤过率(GFR)下降或白蛋白尿升高。大多数CKD患者不知道自己的病情。为了提高识别率,临床指南建议用血清肌酐和尿白蛋白与肌酐比值(uACR)估计的GFR(eGFR)测试高风险患者。

对于T2DM患者,美国糖尿病协会(ADA)建议至少每年检测eGFR和uACR。此外,对于非怀孕的糖尿病和高血压患者,当uACR测量为30-299mg/g时,ADA建议使用ACE抑制剂或血管紧张素受体阻断剂(ARBs),当uACR≥300mg/g和/或eGFR<60ml/min/1.73m2时,强烈建议使用。

为了全面了解美国T2DM患者CKD的检测情况,来自美国医疗集团协会的专家团队开展了一项全国性的研究。分析了来自24家医疗机构和1164个临床实践点的513165名T2DM成人患者的电子健康记录数据。评估了截至2019年9月的1年、2年和3年内,按医疗机构和临床实践地点,同时具有一个或多个eGFRs和一个或多个uACRs的患者百分比,以及每个测试的情况。结果发表在Diabetes Care杂志上。

结果显示,各医疗机构1年内uACR和eGFR的中位检测率为51.6%,eGFR为89.5%,uACR为52.9%。uACR检测在各医疗机构的差异(第10-90百分位数)为44.7%至63.3%,在各医疗机构的差异为13.3%至75.4%。在3年内,各机构的uACR检测率中位数为73.7%。

总体而言,检测到的白蛋白尿升高的发生率为15%。检测到的白蛋白尿升高的平均流行率随着各机构uACR检测率的提高而线性增加,在uACR检测率为20%、50%和100%时,估计流行率分别为6%、15%和30%。

将标准扩大到eGFR和过去一年的任何尿蛋白测试,各机构的中位数(第10-90百分位)测试率为66.4%(58.9-72.4%),各临床实践基地的测试率为67.0%(36.9-81.1%)。使用eGFR和任何尿蛋白或ACE抑制剂或ARB,使过去一年各机构的中位数比率提高到80.1%(76.8-84.9%),各临床实践基地的中位数比率为80.8%(56.6-90.1%)。

按机构和临床实践地点划分的eGFR和uACR检测率

综上,虽然T2DM患者的eGFR检测率一致很高,但uACR的检测率并不理想,而且在所考察的机构中变化很大。指南推荐的uACR检测应增加对CKD的检测。

 

参考文献:

Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations. Diabetes Care 2021 Sep; 44(9): 2000-2009.

https://doi.org/10.2337/dc20-2715

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超重和肥胖是日益严重的全球公共卫生问题,Mazdutide可以同时降低体重和血糖水平,本研究旨在综合证据,证明与安慰剂相比,Mazdutide在患有和非糖尿病的成年人中减肥的有效性和安全性。

J Clin Med:外周动脉疾病在伴有缺血性中风、心血管疾病或糖尿病的亚洲高危人群中的研究

外周动脉疾病(PAD)影响全球超过1亿人,本研究的目的是确定伴有缺血性卒中(IS)、心肌梗死、不稳定型心绞痛(CVD)或糖尿病(DM)的亚洲高危人群中PAD的患病率和危险因素。

JAHA:糖尿病和血糖对机械循环支持后心脏改善和不良事件的影响

T2D和LVAD植入前血糖改变了LVAD的心脏功能改善潜力和不良事件的风险。LVAD植入前血糖控制优化对这些结局的有利影响程度和持续时间值得进一步研究。

糖尿病合并细菌性肝脓肿患者的临床特点

比较糖尿病(DM)合并肝脓肿(PLA)与非糖尿病(NDM)合并PLA患者之间的临床特征,以期为临床诊断及治疗提供依据。

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