Glomerular filtration rate changes in normoalbuminuric and microalbuminuric Type 2 diabetic patients and normal individuals

Murussi, Marcia; Gross, Jorge Luiz; Silveiro, Sandra Pinho

doi:10.1016/j.jdiacomp.2005.07.002

Cited by 34 publications

(27 citation statements)

References 20 publications

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“…Variations in the rate of GFR decline in patients with type 2 diabetes with nephropathy have been described before in previous studies, ranging from 0.36 mL/min/1.73m 2 /year among the Japanese population11 to 4.7 mL/min/1.73m 2 /year among Brazilian subjects 19. Several other studies have also suggested an annual decline in GFR within this range 12131828. In our study, we showed an average of 3.3 mL/year drop in GFR and even greater among patients who reached ESRD (5.9 mL/year).…”

Section: Discussionsupporting

confidence: 52%

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients.DESIGN AND SETTING:Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia.PATIENTS AND METHODS:DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 μmol/L; and/or GFR <60 mL/min/1.73m2].RESULTS:Of 1952 files reviewed, 621 (31.8%) met the criteria for DN, and 294 (47%) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m2 to 45.1 (24.1) mL/min/1.73m2 at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3%) patients, with 250 (40.3%) patients doubling their first–hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m2 at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy.CONCLUSION:Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years.

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Section: Discussionsupporting

confidence: 52%

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

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“…Ten excluded studies described the use of novel markers and 29 others were excluded as they did not have any patients with GFR in the hyperfiltration range at baseline or because data were presented in such a way that the baseline GFRs could not be derived. One initially included report was subsequently removed from the analysis because it comprised patients with type 2 diabetes only, and as such was felt to be not comparable to the other studies [21]. In the end, ten cohort studies from six countries following 780 patients were included in this meta-analysis [22][23][24][25][26][27][28][29][30][31].…”

Section: Resultsmentioning

confidence: 99%

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

et al. 2009

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Aims/hypothesis Glomerular hyperfiltration is a wellestablished phenomenon occurring early in some patients with type 1 diabetes. However, there is no consistent answer regarding whether hyperfiltration predicts later development of nephropathy. We performed a systematic review and meta-analysis of observational studies that compared the risk of developing diabetic nephropathy in patients with and without glomerular hyperfiltration and also explored the impact of baseline GFR. Methods A systematic review and meta-analysis was carried out. Cohort studies in type 1 diabetic participants were included if they contained data on the development of incipient or overt nephropathy with baseline measurement of GFR and presence or absence of hyperfiltration. Results We included ten cohort studies following 780 patients. After a study median follow-up of 11.2 years, 130 patients had developed nephropathy. Using a random effects model, the pooled odds of progression to a minimum of microalbuminuria in patients with hyperfiltration was 2.71 (95% CI 1.20-6.11) times that of patients with normofiltration. There was moderate heterogeneity (heterogeneity test p=0.05, measure of degree of inconsistency= 48%) and some evidence of funnel plot asymmetry, possibly due to publication bias. The pooled weighted mean difference in baseline GFR was 13.8 ml min −1 1.73 m −2 (95% CI 5.0-22.7) greater in the group progressing to nephropathy than in those not progressing (heterogeneity test p<0.01). Conclusions/interpretation In published studies, individuals with glomerular hyperfiltration were at increased risk of progression to diabetic nephropathy using study level data. Further larger studies are required to explore this relationship and the role of potential confounding variables.

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“…A small prospective study reported that microalbuminuric, but not normoalbuminuric, participants with type diabetes (n=65, follow-up 10 years) showed a faster annual decline in GFR (as measured by the 51 Cr-EDTA technique) compared with participants without diabetes (25). Nelson et al (26) reported significant annual GFR changes (as measured by urinary clearance of iothalamate) in proteinuric, but not in microalbuminuric, Pima Indians with diabetes (n=194; 4-year follow-up).…”

Section: Discussionmentioning

confidence: 99%

“…Studies of albuminuric patients with type 2 diabetes not receiving early antihypertensive treatment demonstrated that annual GFR decline (as measured by the 51 Cr-EDTA technique) ranged from 10 to 14 ml/min per year (25). Conversely, early antihypertensive treatment significantly reduced albuminuria and improved the rate of annual GFR decline (approximately 5 ml/min per year) in albuminuric patients with type 2 diabetes (29), as was also confirmed by several other studies (28,(32)(33)(34) in which GFR was directly measured by isotopic methods.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes and Preserved Kidney Function

Zoppini¹,

Targher²,

Chonchol

et al. 2012

Clinical Journal of the American Society of Nephrology

196

136

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SummaryBackground and objectives This study examined predictors of the annual decline in estimated GFR (eGFR) in patients with type 2 diabetes and preserved kidney function.Design, setting, participants, & measurements In a prospective, observational cohort study, 1682 individuals with type 2 diabetes and baseline eGFR $60 ml/min per 1.73 m 2 (as estimated by the Chronic Kidney Disease Epidemiology Collaboration equation) were followed for 10 years. Linear regression was used to estimate participants' changes in eGFR over time.Results During follow-up, 263 (15.6%) individuals had a rapid eGFR decline defined as Conclusions Annual eGFR decline is predicted by multiple modifiable risk factors in patients with type 2 diabetes and preserved kidney function.

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Glomerular filtration rate changes in normoalbuminuric and microalbuminuric Type 2 diabetic patients and normal individuals

Cited by 34 publications

References 20 publications

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes and Preserved Kidney Function

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