Papers

Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study

^a Steno Diabetes Center DK 2820 Gentofte Denmark, ^b Centre of Preventive Medicine Glostrup University Hospital DK 2600 Glostrup Denmark, ^c Statistics Novo Nordisk DK 2880 Bagsvaerd Denmark

Correspondence to: Dr Gall

Objective: To evaluate putative risk factors for the development of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) in patients with non-insulin dependent diabetes.
Design: Prospective, observational study of a cohort of white, non-insulin dependent diabetic patients followed for a median period of 5.8 years.
Setting: Outpatient clinic in tertiary referral centre.
Subjects: 191 patients aged under 66 years with non-insulin dependent diabetes and normoalbuminuria (urinary albumin excretion rate<30 mg/24 h) who attended the clinic during 1987.
Main outcome measures: Incipient and overt diabetic nephropathy.
Results: Fifteen patients were lost to follow up. Thirty six of the 176 remaining developed persistent microalbuminuria (30-299 mg/24 h in two out of three consecutive 24 hour urine collections) and five developed persistent macroalbuminuria (300 mg/24 h in two out of three consecutive collections) during follow up. The five year cumulative incidence of incipient diabetic nephropathy was 23% (95% confidence interval 17% to 30%). Cox's multiple stepwise regression analysis revealed the following risk factors for the development of incipient or overt diabetic nephropathy: increased baseline log urinary albumin excretion rate (relative risk 11.1 (3.4 to 35.9); P<0.0001); male sex (2.6 (1.2 to 5.4); P<0.02); presence of retinopathy (2.4 (1.3 to 4.7); P<0.01); increased serum cholesterol concentration (1.4 (1.1 to 1.7); P<0.01); haemoglobin A1c concentration (1.2 (1.0 to 1.4); P<0.05); and age (1.07 (1.02 to 1.12); P<0.01). Known duration of diabetes, body mass index, arterial blood pressure, serum creatinine concentration, pre-existing coronary heart disease, and history of smoking were not risk factors.
Conclusion: Several potentially modifiable risk factors predict the development of incipient and overt diabetic nephropathy in normoalbuminuric patients with non-insulin dependent diabetes.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Bilous, R., Chaturvedi, N., Sjolie, A. K., Fuller, J., Klein, R., Orchard, T., Porta, M., Parving, H.-H. (2009). Effect of Candesartan on Microalbuminuria and Albumin Excretion Rate in Diabetes: Three Randomized Trials. ANN INTERN MED 151: 11-20 [Abstract] [Full text]  
• Maric, C. (2009). Sex, diabetes and the kidney. Am. J. Physiol. Renal Physiol. 296: F680-F688 [Abstract] [Full text]  
• Yilmaz, M. I., Axelsson, J., Sonmez, A., Carrero, J. J., Saglam, M., Eyileten, T., Caglar, K., Kirkpantur, A., Celik, T., Oguz, Y., Vural, A., Yenicesu, M., Lindholm, B., Stenvinkel, P. (2009). Effect of Renin Angiotensin System Blockade on Pentraxin 3 Levels in Type-2 Diabetic Patients With Proteinuria. CJASN 4: 535-541 [Abstract] [Full text]  
• American Diabetes Association, (2009). Standards of Medical Care in Diabetes--2009. Diabetes Care 32: S13-S61 [Full text]  
• American Diabetes Association, (2008). Standards of Medical Care in Diabetes--2008. Diabetes Care 31: S12-S54 [Full text]  
• Saito, K., Sone, H., Kawai, K., Tanaka, S., Kodama, S., Shu, M., Suzuki, E., Kondo, K., Yamamoto, S., Shimano, H., Ohashi, Y., Yamada, N. (2007). Risk Imparted by Various Parameters of Smoking in Japanese Men With Type 2 Diabetes on Their Development of Microalbuminuria: Analysis from the Tsukuba Kawai Diabetes Registry. Diabetes Care 30: 1286-1288 [Full text]  
• Brantsma, A. H., Atthobari, J., Bakker, S. J.L., de Zeeuw, D., de Jong, P. E., Gansevoort, R. T., for the PREVEND Study Group, (2007). What Predicts Progression and Regression of Urinary Albumin Excretion in the Nondiabetic Population?. J. Am. Soc. Nephrol. 18: 637-645 [Abstract] [Full text]  
• American Diabetes Association, (2007). Standards of Medical Care in Diabetes--2007. Diabetes Care 30: S4-S41 [Full text]  
• Costacou, T., Chang, Y., Ferrell, R. E., Orchard, T. J. (2006). Identifying Genetic Susceptibilities to Diabetes-related Complications among Individuals at Low Risk of Complications: An Application of Tree-Structured Survival Analysis. Am J Epidemiol 164: 862-872 [Abstract] [Full text]  
• Hansen, T. K., Gall, M.-A., Tarnow, L., Thiel, S., Stehouwer, C. D., Schalkwijk, C. G., Parving, H.-H., Flyvbjerg, A. (2006). Mannose-binding lectin and mortality in type 2 diabetes.. Arch Intern Med 166: 2007-2013 [Abstract] [Full text]  
• Retnakaran, R., Cull, C. A., Thorne, K. I., Adler, A. I., Holman, R. R., for the UKPDS Study Group, (2006). Risk Factors for Renal Dysfunction in Type 2 Diabetes: U.K. Prospective Diabetes Study 74. Diabetes 55: 1832-1839 [Abstract] [Full text]  
• Parvanova, A. I., Trevisan, R., Iliev, I. P., Dimitrov, B. D., Vedovato, M., Tiengo, A., Remuzzi, G., Ruggenenti, P. (2006). Insulin resistance and microalbuminuria: a cross-sectional, case-control study of 158 patients with type 2 diabetes and different degrees of urinary albumin excretion.. Diabetes 55: 1456-1462 [Abstract] [Full text]  
• De, P., Das, G., Harley, K., Nair, H. (2006). Review: Dual blockade of renin-angiotensin system in diabetic nephropathy: review of literature and local experience. British Journal of Diabetes & Vascular Disease 6: 23-28 [Abstract]  
• American Diabetes Association, (2006). Standards of Medical Care in Diabetes-2006. Diabetes Care 29: S4-S42 [Full text]  
• Zhou, H., Isaman, D. J.M., Messinger, S., Brown, M. B., Klein, R., Brandle, M., Herman, W. H. (2005). A Computer Simulation Model of Diabetes Progression, Quality of Life, and Cost. Diabetes Care 28: 2856-2863 [Abstract] [Full text]  
• Leitao, C. B., Canani, L. H., Bolson, P. B., Molon, M. P., Pinotti, A. F., Gross, J. L. (2005). Urinary Albumin Excretion Rate Is Associated With Increased Ambulatory Blood Pressure in Normoalbuminuric Type 2 Diabetic Patients. Diabetes Care 28: 1724-1729 [Abstract] [Full text]  
• Parving, H.-H., Mogensen, C.E., Thomas, M.C., Brenner, B.M., Cooper, M.E., for the RENAAL study investigators, (2005). Poor prognosis in proteinuric type 2 diabetic patients with retinopathy: insights from the RENAAL study. QJM 98: 119-126 [Abstract] [Full text]  
• Gross, J. L., de Azevedo, M. J., Silveiro, S. P., Canani, L. H., Caramori, M. L., Zelmanovitz, T. (2005). Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care 28: 164-176 [Abstract] [Full text]  
• American Diabetes Association, (2005). Standards of Medical Care in Diabetes. Diabetes Care 28: S4-S36 [Full text]  
• Ruggenenti, P., Fassi, A., Ilieva, A. P., Bruno, S., Iliev, I. P., Brusegan, V., Rubis, N., Gherardi, G., Arnoldi, F., Ganeva, M., Ene-Iordache, B., Gaspari, F., Perna, A., Bossi, A., Trevisan, R., Dodesini, A. R., Remuzzi, G., the Bergamo Nephrologic Diabetes Complications Tri, (2004). Preventing Microalbuminuria in Type 2 Diabetes. NEJM 351: 1941-1951 [Abstract] [Full text]  
• Marshall, S M (2004). Recent advances in diabetic nephropathy. Postgrad. Med. J. 80: 624-633 [Abstract] [Full text]  
• Polhill, T. S., Saad, S., Poronnik, P., Fulcher, G. R., Pollock, C. A. (2004). Short-term peaks in glucose promote renal fibrogenesis independently of total glucose exposure. Am. J. Physiol. Renal Physiol. 287: F268-F273 [Abstract] [Full text]  
• Hovind, P., Tarnow, L., Rossing, P., Jensen, B. R., Graae, M., Torp, I., Binder, C., Parving, H.-H. (2004). Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ 328: 1105- [Abstract] [Full text]  
• Wong, T. Y., Shankar, A., Klein, R., Klein, B. E.K. (2004). Retinal Vessel Diameters and the Incidence of Gross Proteinuria and Renal Insufficiency in People With Type 1 Diabetes. Diabetes 53: 179-184 [Abstract] [Full text]  
• (2004). Standards of Medical Care in Diabetes. Diabetes Care 27: s15-35 [Full text]  
• Boulware, L. E., Jaar, B. G., Tarver-Carr, M. E., Brancati, F. L., Powe, N. R. (2003). Screening for Proteinuria in US Adults: A Cost-effectiveness Analysis. JAMA 290: 3101-3114 [Abstract] [Full text]  
• Svensson, M., Sundkvist, G., Arnqvist, H. J., Bjork, E., Blohme, G., Bolinder, J., Henricsson, M., Nystrom, L., Torffvit, O., Waernbaum, I., Ostman, J., Eriksson, J. W. (2003). Signs of Nephropathy May Occur Early in Young Adults With Diabetes Despite Modern Diabetes Management: Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS). Diabetes Care 26: 2903-2909 [Abstract] [Full text]  
• (2003). Standards of Medical Care for Patients With Diabetes Mellitus. Diabetes Care 26: S33-S50 [Full text]  
• Knudsen, S. T., Bek, T., Poulsen, P. L., Hove, M. N., Rehling, M., Mogensen, C. E. (2002). Macular Edema Reflects Generalized Vascular Hyperpermeability in Type 2 Diabetic Patients With Retinopathy. Diabetes Care 25: 2328-2334 [Abstract] [Full text]  
• Trevisan, R., Vedovato, M., Mazzon, C., Coracina, A., Iori, E., Tiengo, A., Del Prato, S. (2002). Concomitance of Diabetic Retinopathy and Proteinuria Accelerates the Rate of Decline of Kidney Function in Type 2 Diabetic Patients. Diabetes Care 25: 2026-2031 [Abstract] [Full text]  
• Jude, E.B., Anderson, S.G., Cruickshank, J.K., Srivatsa, A., Tentolouris, N., Chandrasekaran, R., Gokal, R., Boulton, A.J.M. (2002). Natural history and prognostic factors of diabetic nephropathy in type 2 diabetes. QJM 95: 371-377 [Abstract] [Full text]  
• Murussi, M., Baglio, P., Gross, J. L., Silveiro, S. P. (2002). Risk Factors for Microalbuminuria and Macroalbuminuria in Type 2 Diabetic Patients: A 9-year follow-up study. Diabetes Care 25: 1101-1103 [Full text]  
• Mauer, M., Drummond, K. (2002). The Early Natural History of Nephropathy in Type 1 Diabetes: I. Study Design and Baseline Characteristics of the Study Participants. Diabetes 51: 1572-1579 [Abstract] [Full text]  
• Jager, A., Kostense, P. J., Nijpels, G., Dekker, J. M., Heine, R. J., Bouter, L. M., Donker, A. J. M., Stehouwer, C. D. A. (2001). Serum Homocysteine Levels Are Associated With the Development of (Micro)albuminuria : The Hoorn Study. Arterioscler. Thromb. Vasc. Bio. 21: 74-81 [Abstract] [Full text]  
• Melville, A, Richardson, R, Lister-Sharp, D, McIntosh, A (2000). Complications of diabetes: renal disease and promotion of self-management. Qual Saf Health Care 9: 257-263 [Full text]  
• LEMLEY, K. V., BLOUCH, K., ABDULLAH, I., BOOTHROYD, D. B., BENNETT, P. H., MYERS, B. D., NELSON, R. G. (2000). Glomerular Permselectivity at the Onset of Nephropathy in Type 2 Diabetes Mellitus. J. Am. Soc. Nephrol. 11: 2095-2105 [Abstract] [Full text]  
• (1998). Other Articles Noted. Evid. Based Nurs. 1: 100-104 [Full text]  
• British Cardiac Society, , British Hyperlipidaemia Association, , British Hypertension Society, , endorsed by the British Diabetic Association, (1998). Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 80: 1S-29 [Full text]