Background: The relationship between estimated glomerular filtration rate (eGFR) trajectories and myocardial infarction (MI) has so far been unclear in people with diabetes or prediabetes. We aimed to identify common eGFR trajectories in people with diabetes or prediabetes and to examine their association with MI risk.
Methods: The data of this analysis were derived from the Kailuan study, which was a prospective community-based cohort study. The eGFR trajectories of 24 723 participants from the year 2006 to 2012 were generated by latent mixture modeling. Cox proportional hazards models were used to calculate hazard ratios (HR) and their 95% CI for the subsequent risk of MI of different eGFR trajectories.
Results: We identified five distinct eGFR trajectories during 2006 to 2012 and named them according to their eGFR range and pattern over time: low-stable (9.4%), moderate-stable (31.4%), moderate-increasing (29.5%), high-decreasing (13.9%), and high-stable (15.8%). During a mean follow-up of 4.61 years, there were a total of 235 incident MI. Although the high-decreasing group had similar eGFR levels to the moderate-stable group during the last exposure period, the risk was much higher (adjusted HR, 3.57; 95% CI, 1.63-7.85 vs adjusted HR, 2.88; 95% CI, 1.36-6.08). Notably, the moderate-increasing group had reached the normal range, but still had a significantly increased risk (adjusted HR, 2.63; 95% CI, 1.24-5.55).
Conclusions: eGFR trajectories were associated with MI risk in people with diabetes or prediabetes. These observations suggest that long-term trajectories of eGFR may be important for risk prediction of MI and should be highlighted in primary prevention.
背景: 在糖尿病或糖尿病前期患者中，肾小球滤过率(estimated glomerular filtration rate, eGFR)的变化轨迹和心肌梗死(myocardial infarction, MI)的关系至今尚不清楚。因此，我们研究的目的是在糖尿病或糖尿病前期患者中确定eGFR的变化轨迹，并探索不同eGFR的变化轨迹与心肌梗死的关系。 方法: 本研究的分析数据来自于开滦研究。开滦研究是一项基于社区的前瞻性队列研究。我们利用潜在混合模型，在24,723个参与者中模拟了2006到2012年eGFR的变化轨迹，并利用Cox比例风险模型计算不同eGFR变化轨迹的MI风险比(Hazard ratios, HR)和95%置信区间(Confidence Interval, CI)。 结果: 我们在2006年至2012年期间确定了5个不同的eGFR轨迹，并且根据eGFR范围和随时间变化的模式，对其进行命名:低-稳定组(占总人群的9.4%)、中-稳定组(31.4%)、中-高组(29.5%)、高-中组(13.9%)和高-稳定组(15.8%)。在平均随访4.61年期间，MI共发生235例。尽管高-中组和中-稳定组在最后一个随访期有着相同的eGFR水平，但MI的发生风险(校正后的HR为3.57, 95%CI为1.63-7.85)明显高于后者(HR, 2.88, 95%CI, 1.36-6.08)。并且发现，中-高组即使eGFR水平达到了正常范围，MI的发生风险依然显著增加(校正后HR, 2.63, 95%CI, 1.24-5.55)。 结论: eGFR轨迹与糖尿病或糖尿病前期患者的MI风险相关。这些结果表明，eGFR的长期轨迹对MI的风险预测很重要，并且应在一级预防中予以强调。.
Keywords: cohort study; estimated glomerular filtration rate (eGFR); myocardial infarction; trajectory; 心肌梗死; 肾小球滤过率; 轨迹; 队列研究.
© 2020 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.