医学
蛋白尿
肾功能
内科学
危险系数
糖尿病
生物电阻抗分析
肾脏疾病
2型糖尿病
中性粒细胞与淋巴细胞比率
内分泌学
肾
体质指数
置信区间
淋巴细胞
作者
Mei Chung Moh,Sui Pheng Low,Yijie Shao,Subramaniam Tavintharan,Chee Fang Sum,Su Chi Lim
标识
DOI:10.1016/j.diabres.2023.110634
摘要
Aims We explored the predictive utility of baseline neutrophil/lymphocyte ratio (NLR), which reflects a systemic inflammatory tone, in kidney impairment in type 2 diabetes mellitus (T2DM); and investigated the effect of extracellular water/total body water (ECW/TBW) ratio on the relationship. Methods This longitudinal study included 1,224 T2DM adults recruited from a single centre. Cox regression analyses examined the association between NLR and progressive kidney function decline or albuminuria progression. Improvements in risk discrimination were assessed using Harrell’s concordance-statistics. The mediatory role of ECW/TBW ratio estimated by bioelectrical impedance was evaluated. Results Higher baseline NLR levels were observed in cases with kidney function decline or albuminuria progression over a median 2-year follow-up. NLR independently predicted progressive kidney function decline (hazard ratio:1.39, 95% CI:1.21–1.60, P < 0.001) or albuminuria progression (hazard ratio:1.34, 95% CI:1.08–1.68, P = 0.009). Addition of NLR to a base model comprising demographics, T2DM duration, metabolic and renal parameters, and medications significantly improved the risk discrimination of kidney function decline (P = 0.022) but not albuminuria progression. ECW/TBW ratio accounted for 19.7% of the total effect between NLR and kidney function loss. Conclusions Increased NLR reflecting systemic inflammation is associated with progressive kidney function decline in T2DM, partially explained by dysregulated body fluid balance.
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