| ObjectiveTo investigate the prevalence and risk factors of occult renal disease (ORD) in hospitalized Type 2 diabetics in Tianjin. To analyze the risk factors of decreased eGFR in hospitalized Type 2 diabetics. To analyze the risk factors of decreased eGFR in hospitalized male and female Type 2 diabetics. To analyze the risk factors of decreased eGFR in different age group.Methods1.1186 diabetics (1999 WHO diagnostic criteria) hospitalized in Tianjin Metabolic Hospital for the first time between 2001.1.1 and 2008.12.31 were recruited, the following is excluded:diabetes mellitus of other type except for Type 2 diabetes mellitus(T2DM); T2DM with acute complications; patients younger than 20 years or older than 80 years old; patients with renal transplantation history or under dialysis; patients with muscular atrophy or deficiency of limb. Finally 1068 Type 2 diabetics were included.2. Estimated glomerular filtration rate (eGFR) was calculated using MDRD formula. All the patients were divided into two groups according to eGFR:the decreased eGFR group whose eGFR＜60ml/min/1.73m2, the normal eGFR group whose eGFR≥60ml/min/1.73m2. The clinical and laboratory data was compared between the two groups. Logistic regression was used to analyze the risk factors of decreased eGFR in hospitalized Type 2 diabetics.3. The definition of ORD:eGFR＜60ml/min/1.73m2 with normal urine albumin excretion rate and serum creatinine. The prevalence of ORD was calculated.4. All the patients were stratified by gender, and then grouped by eGFR. The clinical and laboratory data was compared between the decreased and the normal eGFR group. Logistic regression was used to analyze the risk factors of decreased eGFR in Type 2 diabetics in male and female respectively, the similarities and differences between male and female were compared.5. All the patients were divided into 4 groups according to age(years):≤50 group 50-59 group,60-69 group and≥70group,the prevalence of decreased eGFR was calculated in each group. All the patients were stratified by age into＜60 and≥60 group, then divided into decreased eGFR and normal eGFR group, clinical and laboratory data was compared between the two group. The risk factors of decreased eGFR for Type 2 diabetics in≤60 and≥60 patents were analyzed and compared. Results1. Comparison of clinical and laboratory data between the decreased and the normal eGFR group:compared with the normal eGFR group, patients in the decreased eGFR group were older, had more female, longer disease duration, higher proportion of diabetic retinopaty and hypertension, higher level of serum uric acid(SUA), blood urea nitrogen (BUN), serum creatinine(Scr), triglyceride(TG) and C-reactive protein(CRP); but with lower level of hemoglobin, glycohemoglobin and urine uric acid excretion (UUAE). Moreover, body mass index (BMI), SBP, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and HOMA-IR were higher in the decreased eGFR group, but not statistically significant.2. The risk factors for decreased eGFR in hospitalized Type 2 diabetics:eGFR was chosen as dependent variable (eGFR<60ml/min/1.73m2 vs eGFR≥60ml/min/1.73m2), then in logistic regression, female, age, diabetes duration, hypertension, SUA, BUN, TG, VLDL-C and CRP)were considered as the relative risk factors of decreased eGFR in hospitalized Type 2 diabetics.3. The prevalence of ORD was 15.9% in the decreased eGFR group, and 2.24% in hospitalized Type 2 diabetics. Female, age, SBP and smoking habit were considered as the risk factors for ORD after logistic regression analysis.4. After all the patients were stratified by gender, we got the following results:(1) Te similarities between two groups:compared with the normal eGFR group, patients in the decreased eGFR group were older, had longer diabetes duration, and higher proporation of patients with hypertension and albuminuria, higher level of SUA and Scr, lower level of UUAE. Age, diabetes duration, SUA, CRP and hypertension were considered as the common risk factors of decreased eGFR in both male and female Type 2 diabetic patients. (2) In the male group:compared with the normal eGFR group, patients in the decreased eGFR group had higher levels of SBP and CRP, higher proportion of patients with diabetic retinopaty, and lower proportion of patients with smoking habits. SBP was considered as relative risk factors of decreased eGFR for male patients after logistic regression. (3) In the female group:compared with the normal eGFR group, patients in the decreased eGFR group had higher levels of BUN and TG, higher proportion of patients with smoking habits, and lower level of DBP, lower proportion of patients with diabetes family history. Smoking habits, TC, TG, LDL-C, and VLDL-C were considered as risk factors of decreased eGFR for female patients. 5. After all the patients were divided by gender, we got the following results:the prevalence of decreased eGFR was 4.8%,8.2%,17.3% and 28.3% in the≤50 group, 50-59 group,60-69 group and≥70 group respectively. Diabetes duration, SUA, VLDL, hypertension and CRP were considered as risk factors for patients in＜60 group; female, hypertension, LDL-C, hemoglobin and UUAE were considered as relative risk factors of decreased eGFR for patients in≥60 group.Conclusion1. The combination of abnormal UAER and Scr failed to detect 2.24% patients with early-stage renal injury in Type 2 diabetics, the missed diagnosis appeared more often in female, the aged, patients with smoking habit and DBP dominant hypertension.2. The decreased eGFR appeared more often in female, the aged, patients with longer diabetes duration and hypertension, patients with elevated SUA,BUN,TG,VLDL-C and CRP. We should pay more attention to these situations, so as to prevent the progress of DN.3. The risk factors of decreased eGFR had sex difference.SBP was considered as risk factors for male patients. Smoking habit, TC, TC, LDL-C and VLDL-C were considered as risk factors for female patients.4. The risk factors of decreased eGFR had age difference. Diabetes duration, SUA, VLDL-C, CRP and hpertension were considered as risk factors for patients in＜60group; female, hypertension, hemoglobin, LDL-C and UUAE were considered as risk factors for patients in≥60 group. |
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