OBJECTIVE The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We investigated the associations of eGFRdiff with overall DMCs and subtypes, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). RESEARCH DESIGN AND METHODS This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes. RESULTS During a median follow-up of 13.6 years, DMCs developed in 5,753 participants, including 2,752 cases of DR, 3,203 of DKD, and 1,149 of DN. Each SD decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10% decrease in eGFRrediff, the corresponding hazard ratios (95% CIs) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN. The magnitude of associations was not materially altered in all sensitivity analyses. CONCLUSIONS Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff among diabetes population has potential benefit for identification of high-risk patients.

中文翻译：

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成人糖尿病患者中基于胱抑素 C 和肌酐的估计肾小球滤过率与糖尿病微血管并发症风险之间的差异：一项基于人群的队列研究

目的 胱抑素 C 和基于肌酐的估计肾小球滤过率 (eGFRdiff) 之间的差异对糖尿病微血管并发症 (DMC) 的影响仍不清楚。我们研究了 eGFRdiff 与整体 DMC 和亚型的关联，包括糖尿病视网膜病变 (DR)、糖尿病肾病 (DKD) 和糖尿病神经病变 (DN)。研究设计和方法 这项前瞻性队列研究包括来自英国生物银行的 25,825 名基线时（2006 年至 2010 年）没有 DMC 的糖尿病参与者。eGFRdiff 使用基于胱抑素 C 和肌酐的计算之间的绝对差 (eGFRabdiff) 和比率 (eGFRrediff) 进行计算。使用电子健康记录确定 DMC 的发生率。Cox 比例风险回归模型用于评估 eGFRdiff 与总体 DMC 和亚型的关联。结果 在中位随访 13.6 年期间，5,753 名参与者出现 DMC，其中 2,752 例 DR、3,203 例 DKD 和 1,149 例 DN。eGFRabdiff 的每一次 SD 降低都与总体 DMC 风险增加 28%、DR 风险增加 14%、DKD 风险增加 56% 以及 DN 风险增加 29% 相关。eGFRrediff 每降低 10%，总体 DMC 的相应风险比 (95% CI) 为 1.16 (1.14, 1.18)，DR 为 1.08 (1.05, 1.11)，DKD 为 1.29 (1.26, 1.33)，DKD 为 1.17 (1.12)。 ，1.22) 对于 DN。在所有敏感性分析中，关联的程度并未发生实质性改变。结论 大 eGFRdiff 与 DMC 及其亚型的风险独立相关。我们的研究结果表明，监测糖尿病人群中的 eGFRdiff 对于识别高危患者具有潜在益处。