A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy

Parving, Hans‐Henrik; Smidt, U; Friisberg, B; Bonnevie‐Nielsen, V.; Andersen, Andreas

doi:10.1007/bf00253407

Cited by 194 publications

(94 citation statements)

References 14 publications

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“…In other studies blood pressure was found to be higher in patients with microalbuminuria (before GFR decreases) than in those with normoalbuminuria, [10,22,23] but a Danish study suggested that blood pressure does not rise until microalbuminuria has been established for several years [24]. Studies showing that a parental history of hypertension is associated with nephropathy in the offspring [25,26,44] suggest that, at least to some extent, elevations in blood pressure precede the onset of renal disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2001

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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)

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Section: Discussionmentioning

confidence: 99%

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

et al. 2001

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“…In patients with Type 1 diabetes, systemic hypertension has been shown to enhance the development of diabetic nephropathy, while effective antihypertensive treatment reduces albuminuria and diminishes the rate of decline in glomerular filtration rate [29,30]. Systemic hypertension is frequent in Type 2 diabetic patients with elevated urinary albumin excretion [9].…”

Section: Discussionmentioning

confidence: 99%

Glomerular size-and charge selectivity in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy

et al. 1994

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“…RESEARCH DESIGN AND METHODS -We identified all albuminuric type 1 diabetic patients (n ϭ 301) followed for at least 3 years, median (range) 7 years (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), who underwent at least yearly measurement of glomerular filtration rate (GFR) by the 51 Cr-EDTA plasma clearance technique (n ϭ 8, range 3-24). In total, 192 men and 109 women were included (age [mean Ϯ SD] 36 Ϯ 11 years, duration of diabetes 22 Ϯ 8 years); 271 patients were treated with antihypertensive drugs, predominantly ACE inhibitors in 179 patients.…”

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Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes

Hovind

Rossing²,

Tarnow³

et al. 2003

Diabetes Care

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OBJECTIVE -Cigarette smoking contributes to development of diabetic nephropathy. However, long-term studies on the effect of smoking on decline in kidney function in diabetic nephropathy are lacking. We assessed the impact of smoking on progression of diabetic nephropathy in type 1 diabetic patients enrolled in a prospective observational cohort study started in 1983.RESEARCH DESIGN AND METHODS -We identified all albuminuric type 1 diabetic patients (n ϭ 301) followed for at least 3 years, median (range) 7 years (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), who underwent at least yearly measurement of glomerular filtration rate (GFR) by the 51 Cr-EDTA plasma clearance technique (n ϭ 8, range 3-24). In total, 192 men and 109 women were included (age [mean Ϯ SD] 36 Ϯ 11 years, duration of diabetes 22 Ϯ 8 years); 271 patients were treated with antihypertensive drugs, predominantly ACE inhibitors in 179 patients. Patients were classified as smokers if they smoked more than one cigarette per day during a portion of or the entire observation period. Blood pressure, albuminuria, HbA 1c , and serum cholesterol were measured every 3-4 months during the study. RESULTS -In all 301 patients, the mean (SE) rate of decline in GFR (⌬GFR) was 4.0 (0.2) ml ⅐ min -1 ⅐ year -1 during the investigation period. No difference in ⌬GFR was demonstrated between nonsmokers (n ϭ 94), ⌬GFR 4.5 (0.4), ex-smokers (n ϭ 31), ⌬GFR 3.1 (0.7), and smokers (n ϭ 176), ⌬GFR 3.9 (0.3) ml ⅐ min -1 ⅐ year -1 , respectively (NS). Adjustment for other risk factors for progression of diabetic nephropathy did not alter the results: smoking was not associated with ⌬GFR, whereas blood pressure, albuminuria, HbA 1c , and serum cholesterol were demonstrated to be independent progression promoters.CONCLUSIONS -In our study, smoking was not associated with decline in kidney function in type 1 diabetic patients with diabetic nephropathy. Diabetes Care 26:911-916, 2003

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A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy

Cited by 194 publications

References 14 publications

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

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

Glomerular size-and charge selectivity in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy

Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes

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