Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

Abstract

Diabetes accounts for one third or more of all new end stage renal disease in the United States and accounts for at least 16 % of all new patients going onto renal replacement therapy in Europe [1]. The most common cause of end stage renal disease in diabetes is diabetic glomerulosclerosis (nephropathy).Previous studies have shown that hyperglycaemia is an important risk factor for diabetic renal disease [2,3]. More controversy exists on the extent to which systolic blood pressure and lipid disturbances are risk factors for renal disease rather than being a consequence of it. Data on risk factors for renal disease in prospective studies of diabetes are sparse. The Diabetologia (2001) Results. In 959 subjects with Type I (insulin-dependent) diabetes mellitus and 2559 with Type II (noninsulin-dependent) diabetes mellitus, the average follow-up was 8.4 years ( 2.7). By the end of the follow-up period 53 patients in the Type I diabetic group and 134 patients in the Type II diabetic group had developed renal failure (incidence rate 6.3:1000 person years). Increasing age and duration of diabetes were associated with renal failure in Type II and Type I diabetes. In Type II diabetes duration of diabetes was a more important risk factor than age. In both Type I and Type II diabetic retinopathy and proteinuria were strongly associated with renal failure. Systolic blood pressure was associated with renal failure in Type I but not in Type II diabetic patients. ECG abnormalities at baseline, self-reported smoking and cholesterol were not associated with renal failure. Triglycerides were measured in a subset of centres. Among those with Type II, but not Type I diabetes, triglycerides were associated with renal failure independently of systolic blood pressure, proteinuria or retinopathy. In Type II diabetes fasting plasma glucose was associated with renal failure independently of other risk factors. Conclusion/interpretation. We have confirmed the role of proteinuria and retinopathy as markers of renal failure and the importance of hyperglycaemia in renal failure in Type I and Type II diabetes. Plasma triglycerides seem to be an important predictor of renal failure in Type II diabetes. In Type I diabetes systolic blood pressure is an important predictor of renal failure. [Diabetologia (2001)

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

“…It is of note that total cholesterol remained an independent predictor even after the inclusion of eGFR. In the WHO MSWDD study, triacylglycerol was predictive of renal failure in patients with type 2 diabetes, but not in patients with type 1 diabetes [30]. However, this could have been because of the power, since the number of progressors was lower and triacylglycerol was only measured in a sub-sample of patients.…”

Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

“…Several studies of type 2 diabetes have shown an association between CKD, proteinuria and cardiovascular disease (CVD) prevalence [3] and risk [4][5][6][7][8][9][10][11]. However, many of these studies were small and did not examine the independent effects of microalbuminuria, macroalbuminuria and eGFR.…”

Genome-Wide Scans for Diabetic Nephropathy and Albuminuria in Multiethnic Populations

“…603933, available at http://www.ncbi.nlm.nih.gov/omim) is a common microvascular complication of type 1 and type 2 diabetes. Increasing prevalence of diabetic nephropathy and end-stage renal disease (ESRD) attributed to diabetes have been observed, particularly in older adults (1)(2)(3). In 1999 -2003, the estimated prevalence of type 2 diabetes among all ESRD patients in the U.S. was ϳ29.1%, but among new ESRD cases during the same period, it was 40.5% (1).…”