Epidemiology, development and treatment of end-stage renal failure in Type 2 (non-insulin-dependent) diabetic patients in Europe

Raine, A. E. G.

doi:10.1007/bf02374505

Cited by 77 publications

(30 citation statements)

References 10 publications

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“…It is one of the leading causes of renal failure in the western world. 7,8 Microalbuminuria, which arises very early in the disease and is one of the first markers for diabetic nephropathy, is an independent risk factor for cardiovascular disease. It is defined as the excretion of 30-300 mg of albumin per 24 hours (or 20-200 mcg/min or 30-300 mcg/mg creatinine) on 2 of 3 urine collections.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus

Mohan

Sekhar

2015

Int J Adv Med

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Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus

Mohan

Sekhar

2015

Int J Adv Med

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“…T emporal trends of end-stage renal disease (ESRD) caused by diabetic nephropathy are increasing worldwide, so that diabetes represents the second leading cause of dialysis in most centers (1,2). The first sign of renal involvement is microalbuminuria, which affects 20 -40% of patients with type 2 diabetes (3).…”

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confidence: 99%

Progression to Overt Nephropathy in Type 2 Diabetes

Merletti²,

et al. 2003

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OBJECTIVE -The first sign of diabetic nephropathy is microalbuminuria, but its predictive role of progression to overt nephropathy in type 2 diabetes has not yet been clarified. The aims of this study were to assess during 7 years of follow-up the incidence rate of overt nephropathy and the predictive role of microalbuminuria and other baseline variables (blood pressure, lipids, fibrinogen, uric acid, smoking, and HbA 1c cumulative average during follow-up). RESEARCH DESIGN AND METHODS-A prospective population-based study was performed in Casale Monferrato, Italy, including 1,253 type 2 diabetic patients recruited at baseline (1991)(1992), 765 with normoalbuminuria (albumin excretion rate [AER] Ͻ20 g/ min) and 488 with microalbuminuria (AER 20 -200 g/min). All measurements were centralized. A nested case-control study within the cohort was performed, selecting four control subjects, frequency matched for age and attained individual time of follow-up with each case. Conditional regression analysis was performed to assess variables independently associated with risk of progression to overt nephropathy.RESULTS -Of 1,253 total patients, 1,103 (88.0%) were included in the follow-up examination (median 5.33 years); their age and duration of disease at baseline were 68.4 Ϯ 10.5 years and 10.4 Ϯ 6.6 years, respectively. Cases of overt nephropathy were 202, giving an incidence rate of 37.0/1,000 person-years (95% CI 32.3-42.6). In conditional logistic regression analyses, microalbuminuria provided a 42% increased risk with respect to normoalbuminuria (95% CI 0.98 -2.06), independently of duration of diabetes, hypertension, and systolic blood pressure. Other variables independently associated with progression to overt nephropathy were HbA 1c cumulative average (P ϭ 0.002), apolipoprotein B (P ϭ 0.013), fibrinogen (P ϭ 0.02), and HDL cholesterol (P ϭ 0.03).CONCLUSIONS -Of type 2 diabetic patients, 3.7% progress every year to overt nephropathy. Microalbuminuria is associated with a 42% increased risk of progression to overt nephropathy. Other independent predictors are HbA 1c , HDL cholesterol, apolipoprotein B, and fibrinogen. Diabetes Care 26:2150 -2155, 2003T emporal trends of end-stage renal disease (ESRD) caused by diabetic nephropathy are increasing worldwide, so that diabetes represents the second leading cause of dialysis in most centers (1,2). The first sign of renal involvement is microalbuminuria, which affects 20 -40% of patients with type 2 diabetes (3). When macroalbuminuria occurs, glomerular filtration rate declines, with an average reduction of 10 -12 ml ⅐ min Ϫ1 ⅐ yearThe predictive role of microalbuminuria in progression to overt nephropathy in type 2 diabetes has not yet been clarified, however (4 -6). With respect to previous studies, more recent ones have suggested a lesser predictive role (5,6). A benefit of lipid-lowering treatment on risk of progression to overt nephropathy has also been hypothesized (7). Abnormalities in lipoprotein metabolism, such as elevations in triglycerides and apolipoprotein...

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“…iabetic nephropathy is the most common cause of end-stage renal disease in the Western world and is associated with considerable morbidity and mortality (1)(2)(3). The pathogenesis of diabetic nephropathy is likely to be multifactorial: Nephropathy is strongly dependent on the duration of diabetes (4,5); other risk factors include poor glycemic control, hypertension, and hypercholesterolemia (6)(7)(8)(9)(10)(11)(12)(13).…”

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confidence: 99%

Segregation analysis of diabetic nephropathy in Pima Indians.

et al. 2000

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Familial aggregation of diabetic nephropathy suggests the existence of genes determining susceptibility to nephropathy in addition to those leading to diabetes. In the present study, complex segregation analysis was performed in diabetic members of Pima Indian families to determine whether familial aggregation of nephropathy in this population could reflect the action of a single major gene. Nephropathy, defined by a urinary protein-to-creatinine ratio (PCR) ≥500 mg/g, was analyzed as a discrete trait in a class C regressive logistic model. Individuals with PCR <500 mg/g were considered unaffected. Segregation analysis was performed both for nephropathy at the last examination (prevalent cases) and for duration of diabetes at the onset of nephropathy (incident cases). The REGD program was used for the analysis of the prevalent cases and the REGTL program for the incident cases, both from the Statistical Analysis for Genetic Epidemiology package (Case Western University, Cleveland, OH). The analysis of prevalent cases included 2,107 Pima Indians from 715 nuclear families. A subset of 504 of these families containing 1,403 individuals was used in the analysis of incident cases. Analysis of prevalent cases supported the existence of a gene with a major role, in that hypotheses of no major effect and of no transmission of a major effect were rejected (P = 0.00001; P = 0.003), whereas Mendelian transmission was not rejected (P = 0.85). A dominant model provided the best fit, but a recessive model could not be rejected. The analysis of incident cases, however, did not support a major gene effect on duration of diabetes at the onset of nephropathy, and analyses of lifetime occurrence of nephropathy were inconclusive. The analysis of prevalent cases supports the hypothesis of a major genetic effect on susceptibility to diabetic nephropathy in Pima Indians, but the analysis of incident cases does not support a genetic effect on duration of diabetes at the onset of nephropathy. The discrepancy may reflect the difficulty in precisely dating onset of nephropathy. The parameters of the model derived from segregation analysis of prevalent cases may be useful in linkage studies to detect nephropathy susceptibility loci.

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Epidemiology, development and treatment of end-stage renal failure in Type 2 (non-insulin-dependent) diabetic patients in Europe

Cited by 77 publications

References 10 publications

Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus

Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus

Progression to Overt Nephropathy in Type 2 Diabetes

Segregation analysis of diabetic nephropathy in Pima Indians.

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