Progression of kidney disease in type 2 diabetes – beyond blood pressure control: an observational study

Leehey, David J.; Kramer, Holly; Daoud, Tarek M.; Chatha, Maninder; Isreb, Majd

doi:10.1186/1471-2369-6-8

Cited by 44 publications

(36 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surprisingly, though, we found no significant differences in the prevalence of cardiovascular diseases and stroke between progressors and non-progressors, we believe that those patients who did not progress had been in longstanding advanced CKD stage (Table 2). Furthermore, in our study, systolic but not diastolic blood pressure was associated with increased progression of diabetic nephropathy, which is in accordance with previously published data 1119. This is likely due to the fact that type 2 diabetic patients primarily suffer from isolated systolic hypertension.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES:One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients.DESIGN AND SETTING:Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia.PATIENTS AND METHODS:DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 μmol/L; and/or GFR <60 mL/min/1.73m2].RESULTS:Of 1952 files reviewed, 621 (31.8%) met the criteria for DN, and 294 (47%) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m2 to 45.1 (24.1) mL/min/1.73m2 at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3%) patients, with 250 (40.3%) patients doubling their first–hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m2 at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy.CONCLUSION:Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years.

show abstract

Section: Discussionsupporting

confidence: 93%

“…However, our study was not designed to evaluate treatment effects. The renoprotective effects of angiotensin II receptor blockers have been demonstrated in several clinical trials 711…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

View full text Add to dashboard Cite

show abstract

“…Although it has already been reported that hypoalbuminemia was strongly associated with the severity of nephropathy in type 2 diabetic patients [1], there have been no reports on the association between serum albumin and the severity of other microvascular complica- tions, such as retinopathy and neuropathy, in diabetic patients. In the present study, we report two positive findings.…”

Section: Resultsmentioning

confidence: 97%

“…While evolutionary stability may suggest a critical role of the protein, only minor functions, generally related to transport of ions and drugs, of albumin have been documented. Although it has already been reported that hypoalbuminemia and proteinuria were strongly associated with the severity of nephropathy in type 2 diabetic patients [1], the association between serum albumin and the severity of other microvascular complications of diabetes, such as retinopathy and neuropathy and its clinical significance have not yet been elucidated. In addition, the relationship between the serum albumin and the presence of coronary artery disease in type 2 diabetic patients also remains unknown.…”

mentioning

confidence: 99%

Significant Association of Serum Albumin with Severity of Retinopathy and Neuropathy, in Addition to That of Nephropathy, in Japanese Type 2 Diabetic Patients

2008

View full text Add to dashboard Cite

Abstract. Objective: The aim of this study was to determine the association between serum albumin and the severity of microvascular complications and presence of coronary artery disease in type 2 diabetic patients. Patients and Methods: The presence of diabetic complications was assessed in a total of 130 Japanese patients with type 2 diabetes mellitus. Retinopathy was classified as absent, simple or proliferative diabetic retinopathy. Neuropathy was considered to be present when the patient showed absence of Achilles tendon reflex, and also evaluated by measuring the median motor nerve conduction velocity (MNCV) in the nerve conduction study. Results: In relation to retinopathy, there were 83 patients with no retinopathy (absent), 26 with simple retinopathy and 21 with proliferative retinopathy. There was a significant difference in the serum albumin level between the "absent" group and the other two groups. In relation to nephropathy, there were 68 patients with no evidence of nephropathy, 49 with microalbuminuria and 13 with proteinuria. The results of logistic regression analysis with adjustment for three variables (age, gender, serum CRP) revealed that serum albumin was independently related to proliferative retinopathy and proteinuria. In relation to neuropathy, serum albumin was found to be significantly related to the absence of Achilles tendon reflex, MNCV, and MFWL. The results of multiple regression analysis with adjustment for three variables (age, gender, serum CRP) revealed that serum albumin was independently related to MNCV and MFWL. Conclusions: Serum albumin was significantly associated with the severity of retinopathy and neuropathy.

show abstract

“…This recommendation was primarily on basis of the findings of the Action to Control Cardiovascular Risk in Diabetes (27). In a retrospective observational study of patients with type II diabetes and CKD, BP was not a predictor of rate of decline of eGFR (28). Similarly, recent large analyses in predominantly nonproteinuric type II diabetes support a goal SBP of ,140 mmHg (29,30).…”

Section: Discussionmentioning

confidence: 99%

BP and Renal Outcomes in Diabetic Kidney Disease

Leehey

Zhang

Emanuele

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Proteinuric diabetic kidney disease frequently progresses to ESRD. Control of BP delays progression, but the optimal BP to improve outcomes remains unclear. The objective of this analysis was to evaluate the relationship between BP and renal outcomes in proteinuric diabetic kidney disease.Design, setting, participants, & measurements BP data from all 1448 randomized participants in the Veterans Affairs Nephropathy in Diabetes Trial were included in a post hoc analysis. The associations of mean on-treatment BP with the primary end point (decline in eGFR, ESRD, or death), renal end point (decline in eGFR or ESRD), rate of eGFR decline, and mortality were measured.Results The median (25th, 75th percentile) follow-up time was 2.2 (1.2, 3.0) years. There were 284 primary end points. In univariate analyses, both mean systolic and mean diastolic BPs were strongly associated (P,0.001) with the primary end point. After multivariate adjustment, the hazard of developing the primary end point became progressively higher as mean systolic BP rose from ,120 to $150 mmHg (P=0.02), with a significantly higher hazard ratio for 140-149 versus 120-129 mmHg (1.51 [1.06, 2.15]; P=0.02). There was also a significant association of mean diastolic BP with the hazard of developing the primary end point (P,0.01), with a significantly higher hazard ratio when mean diastolic BP was 80-89 versus 70-79 mmHg (1.54 [1.05, 2.25]; P=0.03); there was also a strong trend when mean diastolic BP was ,60 mmHg. Associations between BP and both renal end point and rate of eGFR decline were similar to those with the primary end point. No association of BP with mortality was observed, possibly because of the limited number of mortality events. ConclusionsIn patients with proteinuric diabetic kidney disease, mean systolic BP $140 mmHg and mean diastolic BP $80 mmHg were associated with worse renal outcomes.

show abstract

Progression of kidney disease in type 2 diabetes – beyond blood pressure control: an observational study

Abstract: Background: The risk factors for progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) have not been fully elucidated. Although uncontrolled blood pressure (BP) is known to be deleterious, other factors may become more important once BP is treated.

Cited by 44 publications

References 37 publications

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Significant Association of Serum Albumin with Severity of Retinopathy and Neuropathy, in Addition to That of Nephropathy, in Japanese Type 2 Diabetic Patients

BP and Renal Outcomes in Diabetic Kidney Disease

Contact Info

Product

Resources

About