Introduction This study aimed to determine the prevalence of diabetic kidney disease (DKD) and rapid renal function decline and to identify indices associated with this decline among adults attending a diabetes center in Northern Europe. Research design and methods This is a retrospective cohort study of 4606 patients who attended a diabetes center in Ireland between June 2012 and December 2016. Definition/staging of chronic kidney disease used the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 classification based on data from the most recently attended appointment. Relevant longitudinal trends and variabilities were derived from serial records prior to index visit. Rapid renal function decline was defined based on per cent and absolute rates of estimated glomerular filtration rate (eGFR) change. Multiple linear regression was used to explore the relationships between explanatory variables and per cent eGFR change. Results 42.0% (total), 23.4% (type 1 diabetes), 47.9% (type 2 diabetes) and 32.6% (other diabetes) had DKD. Rapid decline based on per cent change was more frequent in type 2 than in type 1 diabetes (32.8% vs 14.0%, p<0.001). Indices independently associated with rapid eGFR decline included older age, greater number of antihypertensives, higher log-normalized urine albumin to creatinine ratio (LNuACR), serum alkaline phosphatase, thyroid stimulating hormone, variability in systolic blood pressure and variability in LNuACR, lower glycated hemoglobin, high-density lipoprotein cholesterol and diastolic blood pressure, and lack of ACE inhibitor/angiotensin receptor blocker prescription. Conclusions DKD (using the KDIGO 2012 classification) and rapid eGFR decline were highly prevalent among adults attending a hospital-based diabetes clinic in a predominantly Caucasian Northern European country. The burden was greater for adults with type 2 diabetes. Expected as well as potentially novel clinical predictors were identified. Data that support the findings of this study are available from the corresponding author upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

中文翻译：

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在北欧医院糖尿病中心就诊的成年人慢性肾脏病负担和肾功能快速下降

简介 本研究旨在确定糖尿病肾病 (DKD) 和肾功能快速下降的患病率，并确定在北欧一家糖尿病中心就诊的成年人中与这种下降相关的指标。研究设计和方法 这是一项回顾性队列研究，纳入了 2012 年 6 月至 2016 年 12 月期间在爱尔兰一家糖尿病中心就诊的 4606 名患者。慢性肾脏病的定义/分期使用肾脏疾病：改善全球预后 (KDIGO) 2012 年基于数据的分类从最近参加的约会。相关的纵向趋势和变异性来自索引访问之前的系列记录。快速肾功能下降是根据估计的肾小球滤过率 (eGFR) 变化的百分比和绝对率来定义的。多元线性回归用于探索解释变量与 eGFR 变化百分比之间的关系。结果 42.0%（总计）、23.4%（1 型糖尿病）、47.9%（2 型糖尿病）和 32.6%（其他糖尿病）患有 DKD。基于百分比变化的快速下降在 2 型糖尿病中比在 1 型糖尿病中更常见（32.8% 对 14.0%，p<0.001）。与 eGFR 快速下降独立相关的指标包括年龄较大、抗高血压药物数量较多、对数标准化尿白蛋白与肌酐比值 (LNuACR) 较高、血清碱性磷酸酶、促甲状腺激素、收缩压变异性和 LNuACR 变异性、糖化血红蛋白较低、高密度脂蛋白胆固醇和舒张压，以及缺少 ACE 抑制剂/血管紧张素受体阻滞剂处方。结论 DKD（使用 KDIGO 2012 分类）和 eGFR 快速下降在一个以高加索人为主的北欧国家的以医院为基础的糖尿病门诊就诊的成年人中非常普遍。患有 2 型糖尿病的成年人的负担更大。确定了预期的以及潜在的新临床预测因子。支持本研究结果的数据可根据合理要求从相应的作者处获得。与研究相关的所有数据都包含在文章中或作为补充信息上传。支持本研究结果的数据可根据合理要求从相应的作者处获得。与研究相关的所有数据都包含在文章中或作为补充信息上传。支持本研究结果的数据可根据合理要求从相应的作者处获得。与研究相关的所有数据都包含在文章中或作为补充信息上传。