Interaction of hypertension and diabetes on renal function in black NIDDM subjects

Chaiken, Rochelle L; Palmisano, Joanne; Norton, Margaret; Banerji, Mary Ann; Bard, Mara; Sachimechi, Isaac; Behzadi, Hamid; Lebovitz, Harold E.

doi:10.1038/ki.1995.235

Cited by 21 publications

(19 citation statements)

References 25 publications

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“…In the current study, the prevalence of microalbuminuria was similar to that reported by small clinic-based studies (45)(46)(47); however, the white population from the current study had a higher prevalence of microalbuminuria compared with recent treatment trials (48). Nationally, blacks and Hispanics have been shown to have greater odds of microalbuminuria in the general population, but ethnic differences in microalbuminuria have not been reported for those with a diagnosis of diabetes (15,49,50).…”

Section: Discussionmentioning

confidence: 43%

“…In addition, the effect of BP level on micro-or macroalbuminuria could not be assessed in the current study, because BP measurements were not available within the automated database. However, Chaiken et al (46) found that actual level of BP was less predictive of risk of micro-or macroalbuminuria in a black clinic cohort than having a diagnosis of hypertension. Also, because of the observational nature of the study, all laboratory data (including urine albumin determination) were assessed within an 18-mo time frame before the initiation of the survey and not at the same time period for all participants.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension has been shown to increase the risk of microalbuminuria in the absence of diabetes (13,15), and racial and ethnic differences in the risk of hypertension are known to exist (45,46,55,56). Numerous mechanisms have been described to account for racial and ethnic differences in risk of hypertension (57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74), including increased salt sensitivity in blacks (75) and Asians (57), low renin-angiotensin responsiveness in blacks (58,65), decreased excretion of potassium (76), and differences in renal vasculature and nephron number, although controversy exists regarding some proposed mechanisms (77,78).…”

Section: Discussionmentioning

confidence: 99%

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Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population

Young¹,

Katon²,

Korff³

et al. 2005

Journal of the American Society of Nephrology

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The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro-or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro-and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.

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Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population

Young¹,

Katon²,

Korff³

et al. 2005

Journal of the American Society of Nephrology

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“…It is unclear whether the reported racial differences in the prevalence of proteinuria are large enough to account for the heightened risk of ESRD in black diabetic populations [11][12][13]. In previous reports, abnormal proteinuria was present in a maximum of 51% of black type 2 diabetics [8][9][10]. To clarify the prevalence of nephropathy in an indigent black population of type 2 diabetics, we determined the effect of type 2 diabetes duration on proteinuria and sCr in a randomly selected population of diabetic patients residing in North Carolina.…”

Section: Discussionmentioning

confidence: 99%

“…We are unaware of any published long-term prospective evaluation in this population. Other cross sectional analyses of the risk of nephropathy in black type 2 diabetics have been published [8][9][10]. The combined prevalence of microalbuminuria and overt proteinuria was no greater than 51% in any of these reports.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Nephropathy in Black Patients with Type 2 Diabetes mellitus

Gitter

Langefeld²,

Rich³

et al. 2002

Am J Nephrol

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The prevalence of nephropathy in black patients with type 2 diabetes mellitus is poorly defined. We performed a cross-sectional analysis of 98 unrelated and unselected black type 2 diabetic patients treated in indigent care internal medicine clinics to determine the prevalence of proteinuria and nephropathy. Serum creatinine, blood urea nitrogen, urine albumin and urine creatinine concentrations were measured. A Spearman’s rank correlation was computed to test for a relationship between diabetes duration and continuous outcomes. For binary outcomes, an odds ratio and 95% confidence interval were computed for a change of 10 years diabetes duration based on logistic regression. Cases were 61% female, and had mean (± SD) age 59.9 ± 12.5 years, diabetes duration 12.6 ± 9.4 years, body mass index 32.4 ± 9.3 kg/m², hemoglobin A1C (HbA1C) 9.2 ± 2.3%, and serum creatinine concentration 1.60 ± 1.1 mg/dl. For continuous variables, diabetes duration was positively associated with albuminuria (r = 0.31; p = 0.0017), serum creatinine (r = 0.36; p = 0.0003) and blood urea nitrogen concentration (r = 0.36; p = 0.0003). For binary variables, cases with longer diabetes duration were at increased risk for urinary albumin:creatinine >300 µg/mg (p = 0.006), elevated serum creatinine concentration (≧1.4 mg/dl in women or ≧1.6 mg/dl in men; p = 0.045), elevated blood urea nitrogen concentration (≧20 mg/dl; p = 0.026), and clinical cerebrovascular disease (p = 0.028). HbA1C, body mass index, and blood pressure did not correlate with diabetes duration in this population. Among the cases, 33.7% had elevated serum creatinine concentration and 71.5% had abnormal levels of albuminuria (27.6% > 300 µg albumin/mg Cr and 43.9% 30–300 µg albumin/mg Cr). Abnormal proteinuria was seen in the majority of black patients with poorly controlled type 2 diabetes mellitus treated in indigent care clinics. This prevalence may be conservative, due to the widespread use of angiotensin-converting enzyme inhibitor therapy and exclusion of cases treated only by nephrologists. Approximately 70% of black patients with type 2 diabetes cared for in indigent care clinics have abnormal proteinuria and are at heightened risk for ESRD and death.

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End-stage Renal Disease in Specific Ethnic and Racial Groups

Jd²

1998

Arch Intern Med

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During the past few years, it has become apparent that there are factors that place a person at greater risk for the development and progression of renal failure. This has been documented since the early 1980s by the United States Renal Data System that has collected data confirming that end-stage renal disease occurs at a greater rate in certain subpopulations of Americans. It is evident from an examination of the data that African Americans and American Indians have an incidence of end-stage renal disease that is not proportional to their percentage of the total population. In fact, African Americans and American Indians are reported to have at least a 4-fold greater incidence of end-stage renal disease than white Americans. There have been 5 factors identified: hypertension, glucose intolerance, insulin resistance, salt sensitivity, and hyperlipidemia, which may play a greater role in these subpopulations. In addition, as with other populations, lifestyle issues may serve to alter these primary risk factors or may act as direct modulators of renal disease progression. There is also a possibility that interactions between risk factors frequently occur that may modify the development or progression of the disease. This article reviews these risk factors and emphasizes the interaction between hypertension and the other factors. In addition, the effects of antihypertensive agents on risk factors and on renal outcome are emphasized. Where possible, issues specific to African Americans and American Indians are underscored; however, one must accept that the database on these populations is only now developing. This review should help the clinician make appropriate choices when prescribing antihypertensive therapy for patients who may be at risk of developing progressive renal failure.

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Interaction of hypertension and diabetes on renal function in black NIDDM subjects

Cited by 21 publications

References 25 publications

Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population

Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population

Prevalence of Nephropathy in Black Patients with Type 2 Diabetes mellitus

End-stage Renal Disease in Specific Ethnic and Racial Groups

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