Chronic Renal Failure in Non-Insulin-Dependent Diabetes Mellitus

Humphrey, Linda L.; Ballard, David J.; Frohnert, Peter P.; Chu, Chu-Pin; O’Fallon, W. Michael; Palumbo, Pasquale

doi:10.7326/0003-4819-111-10-788

Cited by 176 publications

(94 citation statements)

References 28 publications

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“…Among patients with type 2 diabetes mellitus who are initially free of proteinuria, the 20-yr risk of diabetic nephropathy is 41% (1). After proteinuria occurs, the subsequent 10-yr risk of progressive chronic kidney disease is 11% (2). Thus, about half of those with type 2 diabetes will develop nephropathy and 10% of these individuals will experience progressive loss of renal function.…”

mentioning

confidence: 99%

Risk Factors for Progressive Chronic Kidney Disease

McClellan

Flanders

2003

Journal of the American Society of Nephrology

125

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Abstract. The occurrence of chronic kidney disease and subsequent rate of loss of renal function are highly variable among individuals with the same underlying cause of renal injury or degree of functional impairment. Individual variability of risk is typical of complex diseases and reflects the multifactorial nature of the biologic mechanisms that are involved in the underlying disease process. The utility of the risk factor concept in developing CKD prevention and control strategies includes identifying individuals at high risk for the occurrence and progression of CKD, defining at-risk populations, elucidating potential targets for intervention, and generating explanatory hypotheses for the variable risk of CKD noted in different populations. Future application of the risk factor concept in the prevention and control of CKD will entail developing multivariate prediction equations; using spatial and temporal, as well as personal, characteristics, to define at-risk populations; identifying biomarkers for complex risk factors like race; and translating this information into testable interventions. This should include active extension of our current understanding of health care, social, and economic risk factors at both the individual and the community level.

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confidence: 99%

Risk Factors for Progressive Chronic Kidney Disease

McClellan

Flanders

2003

Journal of the American Society of Nephrology

125

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“…Diabetes is a major risk factor for the initiation and progression of CKD (8,9), and individuals with evidence of the metabolic syndrome have a substantial risk for developing type 2 diabetes over time (2). Epidemiologic studies have linked the metabolic syndrome with an increased risk for microalbuminuria, an early marker of kidney injury (7,10 -13); few studies have evaluated the relation between the metabolic syndrome and CKD (6,7).…”

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confidence: 99%

Metabolic Syndrome and the Risk for Chronic Kidney Disease among Nondiabetic Adults

Kurella¹,

Lo²,

Chertow³

2005

Journal of the American Society of Nephrology

630

486

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The metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease; however, no prospective studies have examined the metabolic syndrome as a risk factor for chronic kidney disease (CKD). A total of 10,096 nondiabetic participants who were in the Atherosclerosis Risk in Communities study and had normal baseline kidney function composed the study cohort. The metabolic syndrome was defined according to recent guidelines from the National Cholesterol Education Program. Incident CKD was defined as an estimated GFR (eGFR) <60 ml/min per 1.73 m 2 at study year 9 among those with an eGFR >60 ml/min per 1.73 m 2 at baseline. T he metabolic syndrome, also known as the insulin resistance syndrome, is characterized by abdominal obesity, dyslipidemia, hypertension, and hyperglycemia and is present in approximately 20% of US adults (1). Individuals with the metabolic syndrome are at increased risk for diabetes and cardiovascular disease (2), as well as cardiovascular and all-cause mortality (3,4). The prevalence of chronic kidney disease (CKD) is also rising, affecting approximately 8 million adults in the United States (5). Cross-sectional studies have demonstrated a link between the metabolic syndrome and CKD (6,7). However, whether the metabolic syndrome contributes to the development of CKD is unknown.Diabetes is a major risk factor for the initiation and progression of CKD (8,9), and individuals with evidence of the metabolic syndrome have a substantial risk for developing type 2 diabetes over time (2). Epidemiologic studies have linked the metabolic syndrome with an increased risk for microalbuminuria, an early marker of kidney injury (7,10 -13); few studies have evaluated the relation between the metabolic syndrome and CKD (6,7). These studies have been limited by cross-sectional design, the inclusion of subjects with diabetes, and the use of proxies of insulin resistance, rather than recently proposed clinical criteria defining the metabolic syndrome (14). To date, no prospective longitudinal studies have examined the risk for CKD among individuals with the metabolic syndrome. It remains unclear whether the syndrome is a cause or a consequence of reduced kidney function and whether the associations are independent of diabetes.To determine whether the metabolic syndrome was associated with the development of CKD, we examined data from a large, community-based, prospective cohort of adults. We hypothesized that among individuals with normal or near-normal kidney function at baseline, the metabolic syndrome would be associated with the development of CKD over time. Moreover, we hypothesized that this association would be independent of diabetes and hypertension, the leading causes of CKD in the United States. Materials and Methods Study PopulationThe Atherosclerosis Risk in Communities (ARIC) Study is a prospective longitudinal study of cardiovascular disease risk factors (15). The ARIC cohort consists of Ͼ15,000 black and white individuals aged 45 to 64 at study entry, sampled at random ...

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“…The number of type 2 diabetic patients with end-stage renal failure is increasing, and imposes a similar, or even greater burden than end-stage renal disease due to type 1 diabetes (US Renal Data System, 1994;Humphrey et al, 1989;Pugh et al, 1995;Raine, 1995;Ritz & Stefanski, 1996;Parving, 1996Parving, ,1998. Type 2 diabetes is said to be the major single cause of end-stage renal disease (US Renal Data System, 1994;Humphrey et al, 1989;Pugh et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

“…Type 2 diabetes is said to be the major single cause of end-stage renal disease (US Renal Data System, 1994;Humphrey et al, 1989;Pugh et al, 1995). Evidence of the beneficial effects of protein restriction on non-diabetic and type 1 diabetic renal disorders is ample and consistent (Fouque et al, 1992;Pedrini et al, 1996;Waugh & Robertson, 1997;Kasiske et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial

Pijls

Vries

Eijk³

et al. 2002

Eur J Clin Nutr

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Objective: Protein restriction delays the progression of non-diabetic and type 1 diabetic renal disorders. This study assessed whether protein restriction delays the onset or early progression of renal disorders in type 2 diabetes. Design: Randomized controlled trial. Outcomes were albuminuria (mg=24 h) and, as an estimate of the glomerular filtration rate, cimetidine-influenced creatinine clearance. Setting: Primary care. Subjects: Patients with type 2 diabetes and microalbuminuria or at least detectable albuminuria, or a diabetes duration > 5 y. Interventions: The experimental group received dietary counselling on protein restriction (n ¼ 63); a control group (n ¼ 68) received the usual dietary advice. The duration of intervention and follow-up was 28 AE 7 months. Results: After 6 months, protein intake differed only by 0.08 g=kg=day between the study groups. Subsequently, this difference decreased and eventually disappeared. An initial effect of protein restriction on albuminuria in favor of the experimental group was not sustained, and the glomerular filtration rate decreased in the experimental group at a 1.6 AE 2.2 ml=min=1.73 m 2 y lower rate than in the control group (P ¼ 0.5). Comparison of patients in the experimental group with a decrease in protein intake of at least 0.20 g=kg=day, with controls with no decrease, indicated a similarly small and insignificant effect on glomerular filtration rate. Conclusions: It is concluded that, in the longer term prevention or delay of renal damage in patients with type 2 diabetes, protein restriction is neither feasible nor efficacious.

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Chronic Renal Failure in Non-Insulin-Dependent Diabetes Mellitus

Cited by 176 publications

References 28 publications

Risk Factors for Progressive Chronic Kidney Disease

Risk Factors for Progressive Chronic Kidney Disease

Metabolic Syndrome and the Risk for Chronic Kidney Disease among Nondiabetic Adults

Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial

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