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2019, vol. 10, br. 2, str. 118-127
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Dijabetesna nefropatija u tipu 2 dijabetesa - učestalost i faktori rizika
Diabetic nephropathy in type 2 diabetes: The frequency and risk factors
aUniverzitet u Istočnom Sarajevu, Medicinski fakultet, Foča, Republika Srpska, BiH + Univerzitetska bolnica Foča, Republika Srpska, BiH bUniverzitet u Istočnom Sarajevu, Medicinski fakultet, Foča, Republika Srpska, BiH cZdravstvena ustanova "Fresenius Medical Care", Centar za dijalizu, Šamac, Republika Srpska, Bosna i Hercegovina dUniverzitet u Beogradu, Medicinski fakultet, Srbija
e-adresa: kovacevicvmarijana@gmail.com
Sažetak
Uvod. Ciljevi rada su bili da se utvrdi učestalost i faktori rizika za dijabetesnu nefropatiju (DN) kod bolesnika sa tipom 2 dijabetesa i faktori povezani sa pogoršanjem funkcije bubrega tokom trogodišnjeg perioda. Metode. Studija je obuhvatila 81 bolesnika sa tipom 2 dijabetesa koji su na početku studije svrstani u dvije grupe: prva, 41 bolesnik sa DN (27 muškaraca, 62,03 ± 7,73 godina) i druga, 40 bolesnika bez DN (17 muškog pola, 61,73 ± 11,55 godina). Svim bolesnicima je uzeta anamneza, urađen objektivni pregled i laboratorijska ispitivanja. Na osnovu rezultata ispitivanja, poslije tri godine bolesnici obje grupe su podijeljeni u podgrupe sa nepromjenjenom funkcijom bubrega i podgrupe sa pogoršanjem funkcije definisanim kao povećanje proteinurija i/ili smanjenje jačine glomerulske filtracije (JGF) za više od 25%. Rezultati. Na početku ispitivanja zabilježena je visoka učestalost poznatih faktora rizika za dijabetes i DN kod obje grupe. Multivarijantna logistička analiza izdvojila je ženski pol i trajanje dijabetesa kao značajne prediktore DN. Nakon tri godine funkcija bubrega se pogoršala kod oko 50% bolesnika sa i bez DN, a u podgrupama sa pogoršanjem funkcije bubrega glikemija našte i HbA1c su bili statistički značajno veći nego u podgrupama sa stabilnom funkcijom bubrega. Linearna regresiona analiza je pokazala da je promjena JGF u trogodišnjem periodu značajno povezana sa starošću bolesnika, trajanjem dijabetesa, sistolnim krvnim pritiskom, razlikom u dijastolnom krvnom pritisku i proteinuriji. Promjena u proteinuriji značajno je povezana sa sistolnim krvnim pritiskom, razlikom u dijastolnom krvnom pritisku, kao i HbA1c i JGF na kraju studije. Zaključak. Kod bolesnika sa tipom 2 dijabetesa ženski pol i duže trajanje dijabetesa izdvojeni su kao značajni faktori rizika za DN, a starost bolesnika, trajanje dijabetesa, povišen krvni pritisak, loša glikoregulacija kao faktori rizika za pogoršanje funkcije bubrega.
Abstract
Introduction. The aim of the study was to determine the frequency and risk factors for diabetic nephropathy (DN) in patients with type 2 diabetes as well as the factors related to kidney function decrease over a three-year period. Methods. The study involved 81 patients with type 2 diabetes, initially classified into two groups: the first group was comprised of 41 patients with DN (27 males; 62.03 ± 7.73 years) while the second one included 40 patients without DN (17 males, 61.73 ± 11.55 years). All of them were subjected to history taking, objective examination as well as laboratory examination. Based on the results of the study lasting for three years, the patients of both groups were divided into subgroups with stable kidney function and subgroups with impaired kidney function, defined as an increase in proteinuria level and/or decrease in estimated glomerular filtration rate (eGFR) by more than 25%. Results. In both groups, high incidence rates of known risk factors for diabetes and DN were recorded at the beginning of the study. The multivariate logistic analysis identified the female sex and the duration of diabetes as significant predictors of DN. After three-year period, kidney function declined in approximately 50% of patients with and without DN. Furthermore, the values of fasting glycemia and HbA1c were statistically higher in the groups with impaired kidney function compared to the ones with stable eGFR. The linear regression analysis revealed that, during three-year period, the change in eGFR was significantly associated with patient age, the duration of diabetes, systolic blood pressure, the difference in diastolic readings and proteinuria. The change in proteinuria was strongly associated with systolic blood pressure, the difference in diastolic readings, as well as with HbA1 and eGFR at the end of the study. Conclusion. In patients with type 2 diabetes, female sex and longer duration of diabetes were identified as significant risk factors for DN, while patient age, the duration of diabetes, elevated blood pressure and poor glucoregulation were identified as risk factors for kidney function decrease.
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