Risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus / 中华全科医师杂志

ABSTRACT

Objective To investigate clinical characteristics and risk factors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD).Methods Two hundred and two T2DM patients aged ≥60 y admitted in Tongren Hospital from August 2009 to February 2012 were enrolled in the study,including 64 cases complicated with CKD (CKD group)and 138 cases without CKD (non-CKD group).Hemoglobin (Hgb),albumin (ALB),glycated hemoglobin A1C (HbA1 c),fasting plasma glucose(FBG),postprandial glucose (PBG),serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),total cholesterol (TC),triglyceride (TG),high densitylipoprotein (HDL-C),low density lipoprotein (LDL-C) were measured and ratio of urinary albumin to creatinine (UAER/CR) were calculated,ankle brachial index (ABI) and ambulatory blood pressure was examined.Results The duration of diabetes in CKD group was longer than that in non-CKD group [(13 ± 11) vs.(10 ± 7) y,t =2.35,P ＜ 0.05].Hgb and ALB in CKD group were lower than those in non-CKD group [(12.1 ± 1.7) vs.(13.3 ±1.3) g/L,(34.4±2.6) vs.(36.8 ±3.4) g/L,t=-5.73,-4.75,allP＜0.01]; UA,TG,24 h systolic blood pressure (SBP),24 h pulse pressure (PP)in CKD group were higher than those in non-CKD group [(367 ± 81) vs.(323 ± 74) μmol/L,(1.6 ± 0.9) vs.(1.3 ± 0.7) mmol/L,(133 ± 14) vs.(127±16)mmHg,(65 ±12) vs.(58 ±12)mmHg,t =3.82,2.50,2.47,3.68,all P＜0.1].The UAER/CR in CKD group and non-CKD group was 86.2 mg/g (24.6-374.8 mg/g) and 6.0 mg/g (3.6-17.8 mg/g),respectively (P ＜ 0.01) and ABI in CKD group and non-CKD group was 0.94 ± 0.18 and 1.03 ±0.18 (-2.78,P ＜0.05).There were no significant differences in FBG,PBG,HbA1c,TC,HDL-C andLDL-C between two groups(t =-2.02,1.47,1.48,-0.53,-1.20,-0.76,all P＞0.05).Logistic regression analysis showed that ALB,TG and UAER/CR were the independent risk factors of CKD in T2DM patients(OR0.79,3.63 and 1.04,95％ CI0.62-1.01,1.45-9.01 and 1.00-1.08).Spearman correlation analysis demonstrated that eGFR was positively associated with Hgb,ALB,ABI (r =0.38,0.33 and 0.28,all P ＜ 0.01),negatively associated with age,BUN,Cr,UA,TG,UAER/CR,24 hSBP and PP in all diabetes patients(r =-0.32,-0.63,-0.89,-0.34,-0.18,-0.65,-0.16 and -0.248,all P ＜0.01).Conclusions ALB,TG,UAER/CR are the independent risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus.