| Objective:1.To analyze risk factors that may influence the progression of diabetic kidney disease(DKD)in type 2 diabetes.2.To explore the correlation between 25-hydroxy vitamin D[25(OH)D]level and DKD incidence in type 2 diabetes.Method:1.A total of 412 type 2 diabetic patients with DKD,who were admitted to the Endocrinology Department of the First Affiliated Hospital with Nanjing Medical University from May to November 2016,were enrolled?2.General data,including gender,age,height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP)and so on,were collected from the subjects.Besides,glycosylated hemoglobin(HbAlc),serum creatine(Scr),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterin(LDL-C)and high density lipoprotein cholesterin(HDL-C)were detected in the subjects.The estimated eGFR values were calculated according to the MDRD simplified formula.Also,the subjects were tested for serum 25(OH)D,microalbuminuria/urine creatine ratio(UACR),24h urine N-acetyl--?-D glucosaminidase(UNAG)and urine Cr.UNAG/Cr ratio was calculated.3.According to UACR,the patients were divided into two groups,normal albuminuria group(UACR<30mg/g)and albuminuria group(UACR?30mg/g),while the second group was further divided into microalbuminuria subgroup(30mg/g?UACR<300mg/g)and Macroalbuminuria subgroup(UACR>300mg/g).A serum 25(OH)D level of and above 50 nmol/L was regarded as a normal level of vitamin D.The subjects were divided into the eGFR Group 0(eGFR?60ml/min*1.73m2)and Group 1(eGFR<60ml/min*1.73m2)according to their eGFR levels.Besides,the patients were divided into Group 0(UNAG/Cr<1.19U/mmol)and Group 1(UNAG/Cr?1.19U/mmol)according to whether UNAG/Cr was higher than the median(the UNAG/Cr median=1.19U/mmol).SPSS 22.0 software was used for statistical processing.Risking factors,UACR,UNAG/Cr and eGFR,were analyzed,and the correlation between incidence of DKD and serum 25(OH)D levels were observed.Result:1.Of 412 patients with type 2 diabetes,231 were males and 181 were females,with an average age of(60 ± 13)years?UNAG/CR ratios increased from the normal albuminuria group to the microalbuminuria subgroup and the Macroalbuminuria subgroup[1.06(0.80,1.47)vs 1.64(1.16,2.12)vs 3.07(2.43,4.02),P<0.01];the eGFR level was lower in the Macroalbuminuria subgroup than the normal albuminuria group and the microalbuminuria subgroup[55.4(38.4,97.6)vs 108.5(91.0,128.4)&105.9(83.2,131.4),P<0.05].UACR was related with gender,age,course of diabetes,course of hypertension,SBP,DBP,HbA1C,TG and LDL-C(r=0.181,0.147,0.224,0.293,0.330,0.145,0.167,0.199 and 0.121,P<0.05);eGFR was related with age,course of diabetes,course of hypertension,SBP,DBP and HbA1C(r=0.187,-0.231,-0.268,-0.106,0.212,0.297,P<0.01);and UNAG/Cr was related with gender,age,course of diabetes,course of hypertension,DBP and HbA1C(r=0.145,0.187,0.184,0.177,0.181,0.232,P<0.01).2.According to regression analysis,it was found that a high systolic blood pressure,a long duration of diabetes,with hypertension and an increased HbA1C level all increased the risk of albuminuria,and the corresponding OR values were 1.029(95%CI 1.014?1.044),1.091(95%CI 1.051?1.132),3.012(95%CI 1.675?5.415)and 1.301(95%CI 1.138?1.487).A long duration of diabetes,a high systolic blood pressure and an increased HbA1C level raised the risk of UNAG/Cr elevation,and the OR values were 1.041(95%CI 1.009?1.074),1.018(95%CI 1.006?1.030)and 1.392(95%CI 1.235?1.568)respectively.A long duration of diabetes,hypertension and a high systolic blood pressure resulted in higher risk of a reduced eGFR level,and the OR values were 1.093(95%CI 1.036?1.153),14.837(95%Cl 1.928?114.178)and 1.027(95%CI 1.004?1.050)accordingly.3.A total of 246 cases(59.7%)presented with vitamin D deficiency.The proportion of vitamin D deficiency was higher in the albuminuria group than the normal albuminuria group(74.8%vs 53.6%,P<0.01);the eGFR Group 1 had a higher proportion of vitamin D deficiency than the eGFR Group 0(71.4%vs 58.9%,P>0.05);and the proportion of vitamin D deficiency was higher in the UNAG/CR Group 1 than in the UNAG/CR Group 0(67.0%vs 52.7%,P<0.05).4.UACR and UNAG/Cr were negatively correlated with 25(OH)D level(r=-0.301 and-0.233,P<0.01 for both),while no correlation was found between eGFR and 25(OH)D,Bivariate logistic regression analysis suggested that,when 25(OH)D was below 50nmol/L,the risks of albuminuria and elevated UNAG/Cr were increased with OR values of 3.193(95%CI 1.853?5.501)and 1.935(95%CI 1.243?3.011)respectively.Conclusion:1.In type-2 diabetic kidney disease patients,renal damage might involve the whole kidney,including glomerulus and renal tubules,while damages might occur at different times.Therefore,UACR,eGFR,UNAG and other indexes suggesting glomerulus and renal tubule damages shall be used to comprehensively evaluate renal functions of a type-2 diabetic kidney disease patient and to timely discover renal dysfunction.2.In our study,risk factors for DKD include duration of diabetes,glycosylated hemoglobin,hypertension,systolic blood pressure and 25(OH)D deficiency.Therefore,in clinical scenario,special attentions should be paid to above mentioned risk factors for evaluation of patient's renal function.3.Vitamin D deficiency is relatively common in patients with type-2 diabetes and more severe in DKD patients.It might increase concurrent DKD risks by affecting glomerulus and renal tubule functions. |
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