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Risk Factors for Albuminuria and Renal Impairment in T2DM

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Risk Factors for Albuminuria and Renal Impairment in T2DM

Abstract and Introduction

Abstract


Background. The aim of this study was to identify clinical risk factors associated with the development of albuminuria and renal impairment in patients with type 2 diabetes (T2D). In addition, we evaluated if different equations to estimate renal function had an impact on interpretation of data. This was done in a nationwide population-based study using data from the Swedish National Diabetes Register.
Methods. Three thousand and six hundred sixty-seven patients with T2D aged 30–74 years with no signs of renal dysfunction at baseline (no albuminuria and eGFR >60 mL/min/1.73 m according to MDRD) were followed up for 5 years (2002–2007). Renal outcomes, development of albuminuria and/or renal impairment [eGFR < 60 mL/min/1.73 m by MDRD or eCrCl > 60 mL/min by Cockgroft–Gault (C–G)] were assessed at follow-up. Univariate regression analyses and stepwise regression models were used to identify significant clinical risk factors for renal outcomes.
Results. Twenty percent of patients developed albuminuria, and 11% renal impairment; thus, ~6–7% of all patients developed non-albuminuric renal impairment. Development of albuminuria or renal impairment was independently associated with high age (all P < 0.001), high systolic BP (all P < 0.02) and elevated triglycerides (all P < 0.02). Additional independent risk factors for albuminuria were high BMI (P < 0.01), high HbA1c (P < 0.001), smoking (P < 0.001), HDL (P < 0.05) and male sex (P < 0.001), and for renal impairment elevated plasma creatinine at baseline and female sex (both P < 0.001). High BMI was an independent risk factor for renal impairment when defined by MDRD (P < 0.01), but low BMI was when defined by C–G (P < 0.001). Adverse effects of BMI on HbA1c, blood pressure and lipids accounted for ~50% of the increase risk for albuminuria, and for 41% of the increased risk for renal impairment (MDRD).
Conclusions. Distinct sets of risk factors were associated with the development of albuminuria and renal impairment consistent with the concept that they are not entirely linked in patients with type 2 diabetes. Obesity and serum triglycerides are semi-novel risk factors for development of renal dysfunction and BMI accounted for a substantial proportion of the increased risk. The equations used to estimate renal function (MDRD vs. C–G) had an impact on interpretation of data, especially with regard to body composition and gender

Introduction


Diabetes is estimated to increase the risk of developing end-stage renal disease (ESRD) 10–12-fold. Diabetes, and especially type 2 diabetes (T2D), is currently the main reason for start of renal replacement therapy, i.e. dialysis or kidney transplantation, in many countries. Even though T2D is one of the leading causes of ESRD, not all patients with T2D develop renal dysfunction and ESRD during their lifetime. Development of albuminuria is used as a sensitive clinical risk marker and predictor to identify those at risk of future development of renal dysfunction and ESRD. But recent studies have shown that albuminuria does not always precede development of renal impairment in T2D, implicating that other markers than albuminuria are needed to monitor renal function in these patients.

The primary aim of this study was to study the development of renal dysfunction defined as albuminuria and/or renal impairment in patients with T2D during 5 years of follow-up, and to identify clinical risk factors associated with the development of renal dysfunction. In addition, as the secondary aim, we evaluated if using two different equations to estimate glomerular filtration rate (GFR), i.e. the MDRD and Cockcroft–Gault equations, may have an impact on the interpretation of data. This was done in a nationwide population-based study using the data from the Swedish National Diabetes Register (NDR).

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