Factors associated with the development of renal complications of diabetes mellitus in São Paulo city

Abstract

The incidence of diabetic end-stage renal failure (ESRF) varies worldwide and risk factors have been demonstrated in several populations. The objective of the present study was to identify possible factors associated with the risk of development of ESRF in patients with diabetes mellitus (DM). Two groups of diabetic subjects were included in a case-control study: 1) one group was submitted to renal replacement therapies, attending dialysis centers in São Paulo city and 2) the same number of controls without clinical nephropathy (two negative dipstick tests for urine protein), matched for duration of DM, were obtained from an outpatient clinic. A standardized questionnaire was used by a single investigator and additional data were obtained from the medical records of the patients. A total of 290 diabetic patients from 33 dialysis centers were identified, and 266 questionnaires were considered to contain reliable information. Male/female ratios were 1.13 for ESRF and 0.49 for the control group. A higher frequency of men was observed in the ESRF group when compared with controls (53 vs 33%, P<0.00001), although logistic regression analysis did not confirm an association of gender and diabetic nephropathy (DN). Similar proportions of non-white individuals were found for both groups. Patients with insulin-dependent diabetes mellitus (IDDM) were less common than patients with non-insulindependent diabetes mellitus (NIDDM), particularly in the control group (3.4 vs 26.3%, P<0.00001, for controls and ESRF patients, respectively); this type of DM was associated with a higher risk of ESRF than NIDDM, as determined by univariate analysis or logistic regression (OR = 4.1). Hypertension by the time of the DM diagnosis conferred a 1.4-fold higher risk of ESRF (P = 0.04), but no difference was observed concerning the presence of a family history. Association between smoking and alcohol habits and increased risk was observed (OR = 4.5 and 5.9, respectively, P<0.001). A 2.4-fold higher risk of ESRF was demonstrated in patients with multiple hospitalizations due to DM decompensation, which suggested poor metabolic control. Photocoagulation and neuropathy were found to be strongly associated with ESRF but not with macrovascular disease. Data collected in our country reinforce the higher risk attributable to IDDM and the association between hypertension and the progression of DN. Indirect evidence for an association with metabolic control is also suggested. Correspondence

Cigarette Smoking and Incident Chronic Kidney Disease: A Systematic Review

“…Furthermore, Ejerblad et al [27] found a slightly increased risk in those who smoked for a longer duration (odds ratio among smokers for >40 years 1.45, 95% confidence interval 1.00–2.09) and in those with a higher cumulative cigarette consumption (odds ratio among smokers for >30 pack years 1.52, 95% confidence interval 1.08–2.14). Higher cumulative doses were associated with an increased risk of developing kidney disease in several other studies [25, 33, 35]. A dose-response relationship was not assessed in most studies.…”

“…The definitions of current smokers varied considerably and in some studies included both those who smoked >100 cigarettes per lifetime and currently smoked [25, 26]; other studies included those who smoked ≥1 cigarette/day for a specified length of time, e.g., 30 days, prior to study enrollment [27,28,29,30], while other studies did not provide a definition [22, 23, 31, 32]. There was also heterogeneity in the baseline renal function assessment and measurement/documentation of CKD outcome; some studies obtained markers of renal injury (proteinuria or serum creatinine or estimated glomerular filtration rate) [8, 9,23,24,25, 27, 28,30,31,32,33,34], and others used diagnosis codes obtained from various reports (i.e., discharge summaries, end-stage renal disease database, or death certificates) [21, 22, 26, 29, 35]. Two studies included in this review excluded diabetics [24, 33].…”

“…Figure 2 displays the risk estimates and confidence intervals of each of the studies that were reviewed. Four case-control studies [9, 22, 28, 33] and three cohort studies [31, 34, 35] found a significant association between smoking and incident CKD among current smokers as compared with nonsmokers (i.e., the overall population). The strength of the association varied among these studies, ranging from 1.11 to 4.54; there were no notable commonalities in these studies.…”

Existe concordância no acometimento renal e retiniano da microangiopatia diabética?

“…O sexo masculino havia se associado a maior risco de ND em alguns estudos (31,32). Embora tenhamos obtido maior número de homens nos grupos complicados, a falta de representatividade da nossa amostra não permite tal análise.…”

Diagnóstico de enfermagem Eliminação urinária prejudicada em pessoas com Diabetes Mellitus

“…Nos homens ocorre maior comprometimento do trato urinário superior associado à proteinúria. E, em mulheres há maior comprometimento do assoalho pélvico (por multiparidade e até mesmo pela disposição anatômica do aparelho urogenital) (15) . A prevalência de sintomas urinários em mulheres de 40 a 60 anos, é de 16,0% de incontinência urinária de esforço, com prevalência maior na faixa etária de 40 a 55 anos (16) .…”