Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area

Abstract

BackgroundKidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM).MethodsCross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate & 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate & 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m2 and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m2, 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m2 without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy.ResultsThe prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20; CI 95% 1.86–2.59), microvascular disease (OR 2.14; CI 95% 1.8–2.54) and insulin treatment (OR 1.82; CI 95% 1.39–2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80–0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21–0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91–0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09–1.3).ConclusionsOne-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD.

SOD2gene Val16Ala polymorphism is associated with macroalbuminuria in Mexican Type 2 Diabetes patients: a comparative study and meta-analysis

“…We observed that adding the SOD2 Val16Ala polymorphism to a model including the aforementioned factors increased only slightly the goodness of fit of the model (McFadden's pseudo R2 values increased from 0.361 to 0.369). Some of the factors identified in our study (male sex, duration of T2D, diastolic blood pressure, HbA1c and LDL cholesterol levels) have also been highlighted in previous studies [29,30]. However, in our sample we found that current or previous smoking was inversely associated with macroalbuminuria.…”

Prevalence and awareness of chronic kidney disease among adult diabetic outpatients in Northeast Ethiopia

“…The overall prevalence of CKD observed in our study was higher than 21.8% prevalence reported from the University of Gondar Hospital study in Northwest Ethiopia [24] and closer to that of 27.5% reported in the Netherland study [25], 27.9% in the Spain PERCEDIME2 study [26] and 29.6% in the Chinese study [27]. However, our prevalence estimate of CKD using a similar definition of eGFR prediction equation was lower than that of 39% reported in Kinshasa, the democratic republic of Congo study [28], 34.1% in Catalonia (Spain) study [29], and 42.3% in the Japanese study [30]. These differences in prevalence might be because of the differences in creatinine assays and calibration, albumin assays or differences in case-mix (in terms of diabetes type).…”

Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study

“…Vinagre et al [17] found a prevalence of 20% for RI and 16.7% for albuminuria. In another study in Spain [8] the prevalence off different types of renal disease in DM2 was: 34,1% for any type of CKD, 22,9% RI and 19,5% for albuminuria. In a study performed in primary care centres in the Netherlands, van der Meer et al [18] observed that 27.6% of DM2 patients had CKD and that 13.6% of these DM2 patients had albuminuria.…”

“…CKD increases the cost of managing DM [7]. CKD commonly initiates at the prediabetes stage due to its coexistence with other CVRF, and CKD is present in one-third of DM2 patients [8]. …”