Sarcopenia Is an Independent Risk Factor for Severe Diabetic Nephropathy in Type 2 Diabetes: A Long-Term Follow-Up Propensity Score–Matched Diabetes Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Data Sources and Study Cohort
2.2. Participant Selection
2.3. Propensity Score Matching and Covariates
2.4. Hazard Ratios of Severe Diabetic Nephropathy
2.5. Statistical Analysis
3. Results
3.1. PSM and Study Cohort
3.2. Kaplan–Meier Cumulative Incidence of Severe Diabetic Nephropathy and Survival Curves of the Sarcopenia and Nonsarcopenia Groups
3.3. Prognostic Factors for Severe Diabetic Nephropathy in Multivariate Cox Regression Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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Nonsarcopenia | Sarcopenia | SMD | |||
---|---|---|---|---|---|
N = 52,583 | N = 52,583 | ||||
N | % | N | % | ||
Age (mean ± SD) | 59.06 ± 15.26 | 58.96 ± 14.56 | 0.0070 | ||
59.00 (49.00, 70.00) | 59.00 (49.00, 70.00) | ||||
Age (years) | 52,583 | 52,583 | 0.0000 | ||
Age ≤ 40 | 5316 | 10.11% | 5316 | 10.11% | |
40 ≤ Age ≤ 50 | 9246 | 17.58% | 9246 | 17.58% | |
50 ≤ Age ≤ 60 | 13, 803 | 26.25% | 13,803 | 26.25% | |
Age > 60 | 24,218 | 46.06% | 24,218 | 46.06% | |
Sex | 52,583 | 52,583 | 0.0000 | ||
Female | 28,499 | 54.20% | 28,499 | 54.20% | |
Male | 24,084 | 45.80% | 24,084 | 45.80% | |
Income Level (NTD) | 52,583 | 52,583 | 0.0690 | ||
Low-Income | 668 | 1.27% | 775 | 1.47% | |
≤20,000 | 34,181 | 65.00% | 32,633 | 62.06% | |
20,001–30,000 | 10,052 | 19.12% | 11,343 | 21.57% | |
30,001–45,000 | 5023 | 9.55% | 5224 | 9.93% | |
>45,000 | 2659 | 5.06% | 2608 | 4.96% | |
Urbanization Level | 52,583 | 52,583 | 0.1000 | ||
Rural | 15,494 | 29.47% | 17,947 | 34.13% | |
Urban | 37,089 | 70.53% | 34,636 | 65.87% | |
aDCSI Score (mean ± SD) | 1.06 ± 1.40 | 1.24 ± 1.45 | 0.1210 | ||
aDCSI Score | 52,583 | 52,583 | 0.1640 | ||
0 | 26,681 | 50.74% | 22,485 | 42.76% | |
1 | 9950 | 18.92% | 11,896 | 22.62% | |
2 | 8247 | 15.68% | 8898 | 16.92% | |
3–4 | 6252 | 11.89% | 7539 | 14.34% | |
≥5 | 1453 | 2.76% | 1765 | 3.36% | |
CCI Score (mean ± SD) | 1.02 ± 1.36 | 1.36 ± 1.98 | 0.1990 | ||
0.00 (0.00, 2.00) | 0.00 (0.00, 2.00) | ||||
CCI Score | 52,583 | 52,583 | 0.0000 | ||
0 | 27,195 | 51.72% | 27,195 | 51.72% | |
≥ 1 | 25,388 | 48.28% | 25,388 | 48.28% | |
Comorbidities | |||||
Congestive Heart Failure | 3017 | 5.74% | 2651 | 5.04% | 0.031 |
Dementia | 1209 | 2.30% | 1296 | 2.46% | 0.011 |
Chronic Pulmonary Disease | 10,121 | 19.25% | 9710 | 18.47% | 0.020 |
Rheumatic Disease | 1174 | 2.23% | 1478 | 2.81% | 0.037 |
Liver Disease | 10,249 | 19.49% | 10,037 | 19.09% | 0.021 |
DM With Complications | 2201 | 4.19% | 2197 | 4.18% | 0.000 |
Hemiplegia and Paraplegia | 879 | 1.67% | 1225 | 2.33% | 0.047 |
Renal Disease | 60 | 0.11% | 71 | 0.14% | 0.006 |
AIDS | 22 | 0.04% | 17 | 0.03% | 0.002 |
Cancer | 5266 | 10.01% | 7124 | 13.55% | 0.1331 |
Gum and Periodontal Disease | 22,873 | 43.50% | 27,061 | 51.46% | 0.1600 |
Peptic Ulcer | 15,567 | 29.60% | 20,094 | 38.21% | 0.1830 |
Sleep Disorder | 26,231 | 49.88% | 28,981 | 55.11% | 0.1400 |
Conjunctival Disease | 18,788 | 35.73% | 23,459 | 44.61% | 0.1820 |
Proteinuria | 816 | 1.55% | 1053 | 2.00% | 0.0340 |
Hyperuricemia | 2347 | 4.46% | 2785 | 5.30% | 0.0390 |
Alcohol-Related Disease | 2252 | 4.28% | 2674 | 5.09% | 0.038 |
Obesity | 1271 | 2.42% | 1616 | 3.07% | 0.0400 |
Coronary Arterial Disease | 12,107 | 23.02% | 13,825 | 26.29% | 0.0760 |
Anemia | 4468 | 8.50% | 5687 | 10.82% | 0.0790 |
Asthma | 609 | 1.16% | 608 | 1.16% | 0.0000 |
Hypertension | 25,721 | 48.92% | 27,787 | 52.84% | 0.0790 |
Hyperlipidemia | 17,397 | 33.08% | 20,623 | 39.22% | 0.1280 |
Current Smoking Habits | 12,123 | 23.05% | 13,388 | 25.46% | 0.0560 |
Former Smoking Habits | 728 | 1.38% | 1011 | 1.92% | 0.0420 |
Drug Use | |||||
Metformin | 21,117 | 40.16% | 21,724 | 41.31% | 0.0230 |
Insulin | 3410 | 6.48% | 3419 | 6.50% | 0.0003 |
ACEIs or ARBs | 14,048 | 26.72% | 10,612 | 20.18% | 0.1550 |
Statins | 16,468 | 31.32% | 19,091 | 36.31% | 0.1060 |
p Value | |||||
Follow-Up (years; mean ± SD) | 7.94 ± 4.18 | 7.43 ± 4.10 | <0.0001 | ||
Follow-Up (years; median [IQR, Q1,Q3]) | 7.46 (2.36, 9.15) | 7.79 (1.75, 8.47) | <0.0001 | ||
Outcomes | |||||
Severe Diabetic Nephropathy | 7169 | 13.63% | 10,723 | 20.39% | <0.0001 |
Diabetic Chronic Kidney Disease | 4302 | 8.18% | 6434 | 12.24% | <0.0001 |
Diabetic End-Stage Kidney Disease | 2867 | 5.45% | 4289 | 8.16% | <0.0001 |
Crude HR (95% CI) | p Value | Adjusted HR * (95% CI) | p Value | |||
---|---|---|---|---|---|---|
Sarcopenia (ref. no) | ||||||
Yes | 1.17 | (1.14, 1.2) | <0.0001 | 1.106 | (1.08, 1.13) | <0.0001 |
Sex (ref. female) | ||||||
Male | 1.216 | (1.19, 1.24) | <0.0001 | 1.292 | (1.26, 1.32) | <0.0001 |
Age (years; ref. Age ≤ 40) | ||||||
40 < Age ≤ 50 | 1.4 | (1.33, 1.47) | <0.0001 | 1.321 | (1.26, 1.39) | <0.0001 |
50 < Age ≤ 60 | 1.765 | (1.69, 1.85) | <0.0001 | 1.553 | (1.48, 1.63) | <0.0001 |
Age > 60 | 2.699 | (2.59, 2.82) | <0.0001 | 2.141 | (2.04, 2.24) | <0.0001 |
Income Levels (NTD; ref. Low-Income) | ||||||
≤ 20,000 | 0.848 | (0.77, 1.24) | 0.2311 | 0.896 | (0.81, 1.19) | 0.2301 |
20,001–30,000 | 0.758 | (0.68, 1.14) | 0.4525 | 0.822 | (0.74, 1.11) | 0.5426 |
30,001–45,000 | 0.596 | (0.54, 1.16) | 0.2972 | 0.76 | (0.68, 1.14) | 0.3482 |
>45,000 | 0.544 | (0.49, 1.26) | 0.6452 | 0.704 | (0.63, 1.17) | 0.3287 |
Urbanization (ref. rural) | ||||||
Urban | 0.876 | (0.76, 1.29) | 0.2352 | 0.972 | (0.95, 1.13) | 0.4234 |
aDCSI Score | ||||||
1 | 1.305 | (1.27, 1.34) | <0.0001 | 1.011 | (1.07, 1.14) | 0.0012 |
2 | 1.572 | (1.52, 1.62) | <0.0001 | 1.073 | (1.03, 1.11) | 0.0002 |
3–4 | 1.821 | (1.76, 1.89) | <0.0001 | 1.095 | (1.05, 1.15) | <0.0001 |
≥ 5 | 2.539 | (2.37, 2.73) | <0.0001 | 1.36 | (1.26, 1.47) | <0.0001 |
CCI ≥ 1 (ref. 0) | 1.313 | (0.88, 1.34) | 0.1409 | 1.076 | (0.95, 1.1) | 0.1247 |
Comorbidities (ref. no) | ||||||
Congestive Heart Failure | 1.193 | (0.55, 1.63) | 0.3405 | 1.117 | (0.68, 1.15) | 0.2591 |
Dementia | 1.215 | (0.58, 1.25) | 0.5016 | 0.948 | (0.91, 1.18) | 0.1434 |
Chronic Pulmonary Disease | 1.066 | (0.43, 1.51) | 0.3942 | 1.216 | (0.88, 1.26) | 0.3863 |
Rheumatic Disease | 1.164 | (0.61, 1.72) | 0.4309 | 1.16 | (0.82, 1.2) | 0.2752 |
Liver Disease | 1.314 | (0.78, 1.35) | 0.3680 | 1.055 | (0.82, 1.09) | 0.4233 |
DM With Complications | 0.967 | (0.94, 1.19) | 0.2181 | 0.907 | (0.88, 1.03) | 0.2483 |
Hemiplegia and Paraplegia | 1.293 | (0.76, 1.33) | 0.4391 | 1.044 | (0.91, 1.07) | 0.4236 |
Renal Disease | 1.289 | (0.86, 1.33) | 0.5925 | 1.021 | (0.99, 1.05) | 0.1395 |
AIDS | 1.206 | (0.87, 1.24) | 0.6320 | 0.971 | (0.94, 1.04) | 0.2375 |
Cancer | 1.356 | (0.42, 1.23) | 0.4051 | 1.001 | (0.97, 1.03) | 0.9730 |
Anemia | 1.31 | (0.86, 1.37) | 0.4827 | 1.186 | (0.94, 1.24) | 0.4028 |
Asthma | 1.294 | (0.85, 1.46) | 0.7921 | 1.005 | (0.89, 1.13) | 0.9297 |
Proteinuria | 1.115 | (0.58, 1.86) | 0.7201 | 1.194 | (0.88, 1.62) | 0.5017 |
Hyperuricemia | 1.399 | (0.73, 1.47) | 0.3294 | 1.131 | (0.87, 1.19) | 0.5302 |
Obesity | 0.963 | (0.89, 1.04) | 0.3465 | 1.028 | (0.95, 1.11) | 0.5025 |
Alcohol-Related Disease | 1.222 | (0.75, 1.30) | 0.4804 | 1.099 | (0.93, 1.16) | 0.6553 |
Coronary Arterial Disease | 1.105 | (0.57, 1.54) | 0.6402 | 1.028 | (0.99, 1.06) | 0.0985 |
Gum and Periodontal Disease | 0.973 | (0.95, 1.03) | 0.1184 | 0.911 | (0.89, 1.03) | 0.2116 |
Peptic Ulcer | 1.297 | (0.87, 1.33) | 0.4781 | 1.038 | (0.91, 1.07) | 0.2251 |
Sleep Disorder | 1.313 | (0.58, 1.34) | 0.5420 | 1.024 | (0.89, 1.05) | 0.2674 |
Conjunctival Disease | 1.222 | (0.79, 1.25) | 0.2508 | 0.973 | (0.95, 1.04) | 0.3337 |
Hypertension | 1.181 | (0.58, 1.65) | 0.2853 | 1.115 | (0.68, 1.15) | 0.4492 |
Hyperlipidemia | 1.236 | (0.71, 1.27) | 0.4903 | 0.951 | (0.92, 1.18) | 0.1324 |
Current Smoking Habits (ref. no) | 1.374 | (0.94, 1.41) | 0.3772 | 1.01 | (0.98, 1.04) | 0.4883 |
Former Smoking Habits (ref. no) | 1.282 | (0.95, 1.43) | 0.7421 | 1.01 | (0.91, 1.13) | 0.8532 |
Drug Use (ref. no) | ||||||
Metformin | 1.086 | (0.75, 1.52) | 0.7704 | 1.021 | (0.91, 1.25) | 0.4502 |
ACEIs or ARBs | 1.087 | (0.94, 1.73) | 0.6713 | 1.069 | (0.93, 1.21) | 0.6710 |
Statins | 1.036 | (0.60, 1.37) | 0.5621 | 1.049 | (0.92, 1.08) | 0.2235 |
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Huang, Y.-M.; Chen, W.-M.; Chen, M.; Shia, B.-C.; Wu, S.-Y. Sarcopenia Is an Independent Risk Factor for Severe Diabetic Nephropathy in Type 2 Diabetes: A Long-Term Follow-Up Propensity Score–Matched Diabetes Cohort Study. J. Clin. Med. 2022, 11, 2992. https://doi.org/10.3390/jcm11112992
Huang Y-M, Chen W-M, Chen M, Shia B-C, Wu S-Y. Sarcopenia Is an Independent Risk Factor for Severe Diabetic Nephropathy in Type 2 Diabetes: A Long-Term Follow-Up Propensity Score–Matched Diabetes Cohort Study. Journal of Clinical Medicine. 2022; 11(11):2992. https://doi.org/10.3390/jcm11112992
Chicago/Turabian StyleHuang, Yen-Min, Wan-Ming Chen, Mingchih Chen, Ben-Chang Shia, and Szu-Yuan Wu. 2022. "Sarcopenia Is an Independent Risk Factor for Severe Diabetic Nephropathy in Type 2 Diabetes: A Long-Term Follow-Up Propensity Score–Matched Diabetes Cohort Study" Journal of Clinical Medicine 11, no. 11: 2992. https://doi.org/10.3390/jcm11112992