진행된 당뇨병성 신증 환자를 포함한 고령의 제 2형 당뇨병 환자에서 신생존에 영향을 미치는 인자들에 관한 후향적 연구 = Retrospective Analysis of Factors Related with Renal Outcomes in Elderly Type 2 Diabetic Patients Including Advanced Diabetic Nephropathy

다국어 초록 (Multilingual Abstract)

Background:Recently, the prevalence of diabetes mellitus in elderly people is increasing in Korea because of an increase in longevity. With advancing age, also a greater proportion of end-stage renal disease (ESRD) patients with complex medical co-morbidity contributes to the higher mortality seen in patients receiving dialysis. Diabetic nephropathy has become the most important cause of ESRD worldwide. More intensive therapeutic manipulation is needed to prevent the progression of diabetic nephropathy, but there are few studies about this subject in type 2 diabetes. The aim of this study is to predict renal outcomes of elderly people with type 2 diabetes and investigate risk factors related with the deterioration of renal function and the development of ESRD.
Methods:Study subjects were 67 elderly patients (over 65 years old) with type 2 diabetes. We retrospectively analyzed risk factors for the end points of doubling of serum creatinine or the development of ESRD (dialysis or transplantation).
Results:17 patients (26.4%) reached the end points during the follow-up period. 16 patients of 43 patients with decreased renal function reached the end points and only one of 24 patients with preserved renal function reached the end points. A univariate analysis revealed significant correlations between renal outcomes and duration of diabetes, anemia, hypoalbuminemia, BUN, baseline serum creatinine, GFR, serum calcium, phosphorus, uric acid levels and the degree of proteinuria. In our multivariate analysis, proteinuria and baseline serum creatinine level were significantly independent risk factors. The risk of doubling of serum creatinine or development of ESRD among patients with baseline urinary protein excretion rate ≥1 g/24h was six times higher compared with the risk among those with urinary protein excretion rate <1 g/24h.
Conclusion:Proteinuria and the degree of baseline kidney dysfunction are significant risk factors that contribute to the deterioration of renal function and the development of ESRD in elderly patients with type 2 diabetes. Proteinuria is the most powerful independent predictor of renal outcomes.

국문 초록 (Abstract)

배 경:최근 우리나라에서 평균 수명이 연장되면서 고령자에서 당뇨병의 유병률이 증가하고 있다. 고령의 환자에서 신대체요법이 필요한 말기 신질환으로 진행할 경우 동반 질환 및 대혈관 합병증에 의한 사망률이 급격하게 증가한다. 당뇨병성 신증은 전세계적으로 말기 신질환의 으뜸 원인이다. 적극적인 치료적 조작을 통해 당뇨병성 신증의 진행을 억제하는 것이 중요함에도 불구하고 제 2형 당뇨병 환자에서의 연구가 드물다. 저자 등은 고령의 제 2형 당뇨병 환자를 대상으로 하여 신생존율의 평가 및 신기능 저하에 영향을 주는 인자들에 관한 연구를 수행하였다.
방 법:65세 이상의 제 2형 당뇨병 환자 67명을 대상으로 의무기록 및 검사 결과를 후향적으로 조사하였다. 추적 조사의 종료 시점은 혈청 크레아티닌이 두 배로 상승한 시점 또는 혈액투석, 복막투석, 신이식 등의 신대체요법을 시작한 시점으로 정하였다.
결 과:대상 환자 중에서 17명 (26.4%)이 추적 종료 시점에 도달하였다. 신기능이 저하된 환자 43명 중에서 16명이 추적 종료 시점에 도달하였고, 신기능이 정상이었던 환자 24명 중에서는 1명만이 추적 종료 시점에 도달하였다. 단변량 분석을 통해 신생존율에 영향을 미치는 의미있는 독립변수로는 당뇨병 유병기간, 혈색소, 혈청 알부민, 요소질소, 혈청 크레아티닌, 사구체 여과율, 혈청 칼슘, 인, 요산 그리고 24시간 요단백 배설량이 있었고, 그 중에서 24시간 요단백 배설량이 가장 강력한 위험 인자이었다. 다변량 분석의 결과 혈청 크레아티닌 농도와 24시간 요단백 배설량이 의미있는 위험 인자이었다. 24시간 요단백 배설량이 1 g 이상인 군에서 1 g 미만인 군에 비하여 혈청 크레아티닌이 두 배로 상승하거나 말기 신질환으로 진행할 수 있는 위험이 6.08 배 높았다.

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