| Background“Early progressive renal function decline”is a new concept proposed by the Joslin Research Center for a new type of diabetic nephropathy model of type 1diabetes.We aimed to examine the risk factors for early progressive renal function decline in patients with type 2 diabetes mellitus(T2DM)and analyze the relationship between early progressive renal function decline and coronary artery disease(CAD).MethodsThis multi-center study was carried out in a total of 395 patients with T2DMrandomly selected from three tertiary hospitals in Tianjin.At the beginning of the study,all patients had no history of coronary artery disease and the estimated glomerular filtration rate(eGFR)in all patients was 90ml/min/1.73m~2 or greater calculated using the simplified 4-variable MDRD formula.Endpoint was the occurrence of coronary artery disease diagnosed by coronary angiography.According to the annual decline rate of eGFR at the end of follow-up,patients were divided into early progressive renal function decline group(?3.3%)and stable renal function group(<3.3%).The prevalence of early progressive renal function decline in patients with type 2 diabetes was analyzed.General information and related laboratory indicators were compared between two groups.And multivariate logistic analysis was used to estimated the possible risk factors for early progressive renal function decline in patients with T2DM.Meanwhile,according to whether the occurrence of coronary artery disease at the end of the follow-up or not,patients were divided into normal group and coronary artery disease group two subgroups.Cox proportional hazards analysis was used to estimated hazard ratios(HRs)for related risk factors of CAD and analyze the its relationship with early progressive renal function decline.The severity of CAD was assessed by the Gensini scores system and the correlation analysis was used to study its relationship with early progressive renal function decline in patients with T2DM.Results364 patients were followed-up successfully for a median time of 36 months.At the end of the follow-up,213 patients(58.52%)developed early progressive renal function decline with an annual decline rate of eGFR of 8.00(5.46,13.85)%,while151 patients(41.48%)still had stable renal function with an annual decline rate of eGFR of-1.19(-4.89,0.92)%.Multivariate logistic regression analysis showed that high fasting plasma glucose(FPG)(OR,1.164;95%CI,1.092-1.240)?LDL?4.14mmol/L(OR,3.095;95%CI,1.349-7.099)?TC?6.22mmol/L(OR,2.487;95%CI,1.078-5.737)were independent risk factors for early progressive renal function decline,while direct bilirubin(D-BIL)(OR,0.831;95%CI,0.719-0.960)was independent protective factor.The incidence of coronary heart disease in early progressive renal function decline group was 34.74%,while the incidence of coronary heart disease in stable renal function group was 19.21%,and the difference was statistically significant(?~2=10.512,P=0.001).The annual decline rate of eGFR was 3.532%(-1.021%,7.936%)in patients without coronary heart disease(ie diabetic group),while the annual decline rate of eGFR was 6.571%(2.408%,11.608%)in patients with coronary heart disease(ie diabetes complicated with coronary heart disease group),and the difference was statistically significant(P=0.002).Multivariate Cox analysis was used to estimated hazard ratios(HRs)for related risk factors of CAD,which showed that compared with stable renal function guoup,early progressive renal function decline group were identified as major risk factor for CAD as well as increased age,while the direct bilirubin and high-density lipoprotein(HDL)were identified as major protective factors for CAD.The median Gensini score was 48 in patients with early progressive renal function decline and coronary heart disease,while the median Gensini score was 30 in patients with stable renal function decline and coronary heart disease,and the difference was statistically significant(u=2.381,P=0.017).The decline in eGFR in patients with a Gensini score between 28 and 55was associated with the severity of coronary artery disease(r=0.513,P=0.002).Conclusion1.Nearly 60%of patients with T2DM will suffer from early progressive renal function decline.Bilirubin,as a natural antioxidant in the body,will affect the progression of early renal function in patients with T2DM.In addition,high levels of fasting plasma glucose,TC and LDL are risk factors for early progressive renal function decline as well.2.There's lack of consistency between early progressive renal function decline and proteinuria progression in type 2 diabetes3.Early progressive renal function decline is an independent risk factor for coronary heart disease in patients with type 2 diabetes.Compared with patients with stable renal function,the incidence of coronary heart disease is significantly higher in patients with early progressive renal function decline,and the severity of coronary lesions is significantly increased.What's more the severity of coronary lesions is closely related to the annual decline rate of eGFR. |
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