Читать книгу Clinical Dilemmas in Diabetes - Группа авторов - Страница 22

Analysis of NHANES data from 1999–2006 revealed that chronic kidney disease (CKD), defined as either reduced kidney function or elevated albuminuria (urinary albumin‐creatinine ratio ≥ 30 mg/g), was present in 17.1% of prediabetics compared to 11.8% of individuals with normoglycemia [59]. A multiethnic study found that 16.1% of subjects with IGT had microalbuminuria, compared to 4% of subjects with NGT [60]. After adjusting for multiple variables, glycemic status was found to be the most significant determinant of urinary albumin concentration. A systematic review and meta‐analysis including 9 studies with 185 452 subjects reported that prediabetes was modestly associated with an increased risk of CKD [61]. After adjusting for established risk factors, the relative risk of CKD was 1.11 (95% CI 1.02–1.21) for subjects with FPG between 6.1–6.9 mmol/L.

The prevalence and five‐year incidence of nephropathy increases as FPG, 2‐h PG, and HbA1c rise [12, 58]. Of note, the association of glycemia with nephropathy is weaker than the association between glycemia and retinopathy. When plotting prevalence of microalbuminuria against FPG, 2‐h PG, and HbA1c, there is a visible inflection point and subsequent increase in microalbuminuria prevalence beyond a FPG of 5.5 mmol/L, 2‐h PG of 5.5 mmol/L (and again at 9.3 mmol/L), and HbA1c of 5.8%. In summary, multiple studies suggest that prediabetic‐range hyperglycemia is associated with higher rates of nephropathy.