河南省城乡40岁以上糖尿病患者慢性肾脏病患病率及其相关因素

Prevalence and risk factors of chronic kidney disease in diabetic population aged over 40 years in Henan province

目的调查河南省城乡40岁以上糖尿病患者慢性肾脏病的患病率及其相关因素。方法横断面研究。2015年6月至2019年7月对河南省许昌、驻马店、洛阳和郑州4个地区40岁以上糖尿病患者慢性肾脏病的罹患情况进行调查。比较慢性肾脏病和无慢性肾脏病两组患者的临床特征,应用多因素logistic回归模型分析糖尿病患者慢性肾脏病的相关因素。结果共纳入3067例糖尿病患者,男1238例,女1829例,年龄(60.9±9.7)岁,其中农村居民占85.8%(2633/3067)。共有1155例受访者罹患慢性肾脏病,慢性肾脏病在糖尿病患者中的总体患病率为37.7%(95%CI:35.9%~39.4%)。与无慢性肾脏病组比较,慢性肾脏病组患者年龄较大[(61.4±10.3)比(60.6±9.3)岁],体质指数较高[(25.8±3.7)比(25.4±3.6)kg/m^(2)],男性(43.2%比38.7%)、城市居民(19.4%比11.0%)和规律饮酒者(15.8%比12.7%)占比较高,罹患高血压(57.0%比37.2%)、高尿酸血症(10.7%比7.1%)和血脂异常(46.5%比42.7%)的比例也较高(均P<0.05)。4.9%(149/3067)的糖尿病患者估算肾小球滤过率(eGFR)<60 ml·min^(-1)·(1.73 m^(2))^(-1),35.6%(1092/3067)存在白蛋白尿。糖尿病患者中城市居民的慢性肾脏病患病率为51.6%(95%CI:50.0%~53.2%),农村居民患病率为35.4%(95%CI:34.4%~36.4%),城乡之间糖尿病患者的慢性肾脏病患病率差异有统计学意义(P<0.001)。多因素logistic回归分析结果显示,规律饮酒(OR=1.27,95%CI:1.00~1.61,P=0.046)、中度体力活动(相对于轻度体力活动)(OR=1.23,95%CI:1.01~1.51,P=0.039)、高血压(OR=2.27,95%CI:1.95~2.64,P<0.001)、血脂异常(OR=1.21,95%CI:1.04~1.40,P=0.012)和高尿酸血症(OR=1.56,95%CI:1.21~2.02,P=0.001)为慢性肾脏病的独立相关因素。结论河南城乡地区40岁以上糖尿病患者的慢性肾脏病患病率较高,饮酒、体力活动度较大、罹患慢性疾病等因素与之相关。

Objective To investigate the prevalence and risk factors of chronic kidney disease(CKD)in diabetic patients aged over 40 years in Henan province.Methods A cross-sectional study was conducted.Diabetic patients aged over 40 years were recruited from four cities including Xuchang,Zhumadian,Luoyang and Zhengzhou in Henan Province between June 2015 and July 2019.Multivariate logistic regression analysis was employed to analyze the risk factors for CKD.Results A total of 3067 diabetic patients were included in this study,including 1238 males and 1829 females.The mean age of all participants was(60.9±9.7)years and 85.8%(2633/3067)of them were living in rural areas.There were 1155 participants who had CKD,and the overall prevalence of CKD was 37.7%(95%CI:35.9%-39.4%).Compared with those without CKD,participants with CKD had older age[(61.4±10.3)vs(60.6±9.3)years],higher proportion of male patients(43.2%vs 38.7%),urban residents(19.4%vs 11.0%)and habitual drinkers(15.8%vs 12.7%),higher body mass index[(25.8±3.7)vs(25.4±3.6)kg/m^(2)],higher proportion of having hypertension(57.0%vs 37.2%),hyperuricemia(10.7%vs 7.1%)and dyslipidemia(46.5%vs 42.7%)(all P<0.05).The prevalence of estimated glomerular filtration rate(eGFR)less than 60 ml·min^(-1)·(1.73 m^(2))^(-1) and albuminuria was 4.9%(149/3067)and 35.6%(1092/3067),respectively.Compared with rural participants[35.4%(95%CI:34.4%-36.4%)],urban participants[51.6%(95%CI:50.0%-53.2%)]had higher prevalence of CKD(P<0.001).Multivariate logistic regression analysis showed that habitual drinker(OR=1.27,95%CI:1.00-1.61,P=0.046),moderate physical activities(OR=1.23,95%CI:1.01-1.51,P=0.039),having hypertension(OR=2.27,95%CI:1.95-2.64,P<0.001),dyslipidemia(OR=1.21,95%CI:1.04-1.40,P=0.012)and hyperuricemia(OR=1.56,95%CI:1.21-2.02,P=0.001)were independent risk factors for CKD.Conclusions The prevalence of CKD is high in diabetic patients who aged over 40 years in Henan province.The associated factors for developing CKD include habitual drinking,heavier physical activities and having chronic diseases.Targeted prevention and intervention for associated factors would be beneficial for controlling CKD in middle and old aged diabetic patients.