Clinical significance of nonalbuminuric renal impairment in type 2 diabetes

Penno, Giuseppe; Solini, Anna; Bonora, Enzo; Fondelli, Cecilia; Orsi, Emanuela; Zerbini, Gianpaolo; Trevisan, Roberto; Vedovato, Monica; Gruden, Gabriella; Cavalot, Franco; Cignarelli, Mauro; Laviola, Luigi; Morano, Susanna; Nicolucci, Antonio; Pugliese, Giuseppe

doi:10.1097/hjh.0b013e3283495cd6

Cited by 220 publications

(235 citation statements)

References 27 publications

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“…Albuminuria was found only in 30% of patients with RI at baseline, in line with previous studies in which the majority of patients with type 2 diabetes and RI were found to be normoalbuminuric [40][41][42]. Both albuminuria and RI are independent risk factors for CVEs and all-cause mortality in type 2 diabetes, with albuminuria being the strongest risk factor and relevant at all levels of renal function.…”

Section: Discussionsupporting

confidence: 88%

Blood pressure level and risk of major cardiovascular events and all-cause of mortality in patients with type 2 diabetes and renal impairment: an observational study from the Swedish National Diabetes Register

et al. 2015

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Aims/hypothesis We assessed the relationship between BP and risk of cardiovascular events (CVEs) and all-cause mortality in patients with type 2 diabetes and renal impairment (estimated GFR<60 ml min −1 1.73 m −2 ) treated in clinical practice. Methods A total of 33,356 patients (aged 75±9 years, diabetes duration of 10±8 years) with at least one serum creatinine and BP value available in the Swedish National Diabetes Register between 2005 and 2007 were followed up until 2011 or death. The relationships between mean BPs, CVEs and all-cause mortality were examined using time-dependent Cox models to estimate HRs, adjusting for cardiovascular risk factors and ongoing medications. Conclusions/interpretation In this nationwide cohort of patients with type 2 diabetes and renal impairment, the risk of CVEs and all-cause mortality increased significantly with both high and low BPs, while an SBP of 135-139 mmHg and DBP of 72-74 mmHg were associated with the lowest risks of CVEs and death.

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Section: Discussionsupporting

confidence: 88%

Blood pressure level and risk of major cardiovascular events and all-cause of mortality in patients with type 2 diabetes and renal impairment: an observational study from the Swedish National Diabetes Register

et al. 2015

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“…Kramer et al, had performed a cross-sectional analysis of a nationally representative sample of adults with T2DM and found that about 30% individuals with eGFR <60 did not have retinopathy or microalbuminuria (70). Data from other cross-sectional studies like RIACE, and longitudinal studies like atherosclerosis risk in communities (ARIC) and UKPDS suggest that normoalbuminuric renal impairment occurs frequently in subjects with T2DM (68, 73-75). Macroangiopathy could potentially be the underlying renal pathology as opposed to microangiopathy, in diabetic patients with normoalbuminuric CKD (73).…”

Section: Introductionmentioning

confidence: 99%

Diabetic Kidney Disease and the Cardiorenal Syndrome

Jindal

Garcia-Touza

Jindal

et al. 2013

Endocrinology and Metabolism Clinics of North America

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Synopsis Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States. There was an estimated 7 million cases of diabetic kidney disease (DKD) in the last National Health and Nutrition Examination survey (2005-2008). High blood pressure, hyperglycemia and other metabolic abnormalities interactively promote DKD, thus there has been increasing interest and renewed focus on the metabolic dysregulation and the interactions between heart and kidney pathologies observed in DKD. Indeed metabolic abnormalities that are observed in overweight or obese individuals are known to impact blood pressure regulation in kidney and cardiovascular disease; e.g. cardiorenal metabolic syndrome. In this context, obesity has been associated with increased blood pressure variability and nocturnal non-dipping which are risk predictors for albuminuria and DKD. These collective metabolic abnormalities have also been observed in earlier stages of DKD in association with micro-albuminuria. Herein we review the current literature regarding the role of blood pressure variability and nocturnal non-dipping of blood pressure as well as the presence of DKD, in the absence of albuminuria, as risk predictors for progressive DKD. We also discuss the importance of glycemic and blood pressure control in patients with diabetes and CKD, and the use of oral hypoglycemic agents and anti-hypertensive agents in this patient cohort.

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“…Der intrarenale arterielle Resistance-Index (RI) war bei Typ-2-Diabetikern mit eingeschränkter Nierenfunktion unabhängig von der Höhe der Albuminurie erhöht [32]. Die nichtalbuminurische diabetische Nierenerkrankung korrelierte mit kardiovaskulären Erkrankungen, sodass sie auch makrovaskuläre Verände-rungen reflektieren dürfte [33].…”

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