Factors Affecting Progression of Renal Failure in Patients With Type 2 Diabetes

Abstract

OBJECTIVE -Hyperglycemia and hypertension are known to be risk factors for the development of proteinuria in patients with diabetes. Little is known, however, about predictors of progression of renal failure in diabetic patients.RESEARCH DESIGN AND METHODS -We investigated factors affecting progression of renal failure by measuring the doubling of serum creatinine (s-Cr) as an end point in a cohort of 85 type 2 diabetic patients with chronic renal insufficiency/failure (s-Cr Ͼ1.5 and Ͻ3.7 mg/dl, 61 Ϯ 11 years old, 51 men and 34 women, mean s-Cr 2.3 Ϯ 0.6 mg/dl).RESULTS -The survey period (mean Ϯ SD) was 14.2 Ϯ 10.8 months. The cumulative incidence of the end point in patients with insulin therapy (n ϭ 41) was significantly lower than that in patients without it (n ϭ 44) (P ϭ 0.0022, P values by log-rank test). Multivariate Cox analysis revealed insulin therapy (hazard ratio [HR] 0.435, 95% CI 0.252-0.750, P ϭ 0.0027), serum albumin (0.484, 284 -0.823, P ϭ 0.0074), mean blood pressure (1.023, 1.004 -1.043, P ϭ 0.017), and hemoglobin (0.841, 0.728 -0.972, P ϭ 0.0194) to be independent and significant predictors of progression to renal failure, whereas HbA 1c or serum cholesterol were not.CONCLUSION -In type 2 diabetic patients with renal failure, hypoalbuminemia, anemia, higher mean blood pressure, and lack of use of insulin predict rapid progression of renal failure, but HbA 1c does not, and insulin therapy may be possibly an indicator of the delay in progression of renal failure.

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

“…This association was confirmed by treating haemoglobin concentration both continuously in the univariate and multivariate regression analyses and categorically in the ANCOVA. These results are consistent with our earlier observation [14] and other hospital-based cohort studies from Japan [15] and Denmark [17] in diabetic subjects with overt nephropathy, which indicated that decreased haemoglobin concentration or lower haematocrit may be an independent risk factor for the progression of kidney disease in diabetic patients, regardless of the presence of albuminuria. A sub-analysis of the Reduction in Endpoints in NIDDM with the Angiotensin II Antagonist Losartan study [16] also identified anaemia as a predictor of further progression of advanced kidney disease in patients with type 2 diabetes.…”

“…In addition, we [14] and others [15][16][17] have demonstrated that decreased haematocrit or haemoglobin levels may be useful in identifying type 2 diabetic individuals at increased risk of progression of kidney disease. These studies have included diabetic patients with advanced stages of nephropathy, defined as an elevated serum creatinine concentration and/or clinical albuminuria; however, the relationship between haemoglobin levels and the progression of kidney disease in diabetic patients without clinical albuminuria is unknown.…”

Prospective Study of Lipoprotein(a) as a Risk Factor for Deteriorating Renal Function in Type 2 Diabetic Patients With Overt Proteinuria

“…In addition, our data agree with those of other previous studies (1,36), demonstrating that baseline albuminuria/ proteinuria is a powerful predictor of nephropathy progression in type 2 diabetic patients. On the other hand, we did not find a beneficial effect of better glycemic control on deterioration of renal function, in accordance with other previous studies (37,38).…”

Anaemia in diabetes: is there a rationale to TREAT?

“…Anaemia is associated with an increased risk of the vascular complications of diabetes including nephropathy [7,25,26], retinopathy [27,28], neuropathy [3], impaired wound healing [29] and macrovascular disease. A reduced Hb, even within the normal range, identifies patients with type 2 diabetes who are at increased risk of progressive renal disease, hospitalisation and premature death [7].…”