Association between hydration status and the risk and all-cause mortality of diabetic kidney disease

This cohort study aimed to explore the relationship between hydration status and the risk of diabetic kidney disease (DKD) as well as all-cause death in DKD patients. Weighted univariable and multivariable logistic regression models were used to explore the association between hydration status and DKD risk in diabetic population while weighted univariable and multivariable Cox regression models were used to identify the association between hydration status and all-cause mortality in DKD patients. Kaplan-Meier curve was plotted to present the survival probability of patients with different hydration status. Estimates were presented as odds ratio (OR), and hazard ratio (HR) with 95% confidence interval (CI). The mean follow-up time was 79.74 (±1.89) months. There were 2041 participants with DKD, and 2889 participants without. At the end of the follow-up, 965 participants were alive. The risk of DKD was increased as the increase of osmolarity level (OR = 1.07, 95%CI: 1.05–1.08). The elevated risk of DKD was observed in patients with impending dehydration (OR = 1.49, 95%CI: 1.19–1.85) or current dehydration (OR = 2.69, 95%CI: 2.09–3.46). The association between increased osmolarty level and elevated risk of all-cause mortality in DKD patients was statistically different (HR = 1.02, 95%CI: 1.01–1.03). Current dehydration was correlated with increased all-cause mortality risk in DKD patients (HR = 1.27, 95%CI: 1.01–1.61). Compared to DKD patients with normal hydration, the survival probability of DKD patients with current dehydration was significant lower (<i>p</i> &lt; 0.001). Increased osmolarity level was associated with increased risk of DKD and elevated risk of all-cause mortality in DKD patients.

本队列研究旨在探讨水合状态与糖尿病群体中糖尿病肾病（diabetic kidney disease, DKD）的发病风险，以及DKD患者的全因死亡风险之间的关联。本研究采用加权单因素及多因素logistic回归模型，探究糖尿病群体中水合状态与DKD发病风险的关联；同时采用加权单因素及多因素Cox回归模型，明确DKD患者中水合状态与全因死亡率的关联。本研究绘制Kaplan-Meier曲线以展示不同水合状态患者的生存概率，统计结果以比值比（odds ratio, OR）、风险比（hazard ratio, HR）及95%置信区间（confidence interval, CI）进行呈现。本研究的平均随访时长为79.74±1.89个月，共纳入2041例DKD患者与2889例无DKD的糖尿病参与者；随访结束时，共有965例参与者存活。血清渗透压水平升高与DKD发病风险增加呈正相关（OR=1.07，95%CI：1.05~1.08）；前驱脱水患者（OR=1.49，95%CI：1.19~1.85）或当前脱水患者（OR=2.69，95%CI：2.09~3.46）的DKD发病风险均显著升高。DKD患者中，血清渗透压水平升高与全因死亡风险升高的关联具有统计学意义（HR=1.02，95%CI：1.01~1.03）；当前脱水与DKD患者的全因死亡风险升高相关（HR=1.27，95%CI：1.01~1.61）。与水合状态正常的DKD患者相比，当前脱水的DKD患者的生存概率显著更低（p<0.001）。综上，血清渗透压水平升高与糖尿病群体的DKD发病风险升高，以及DKD患者的全因死亡风险升高均存在显著关联。