Prevalent Rate of Nonalbuminuric Renal Insufficiency and Its Association with Cardiovascular Disease Event in Korean Type 2 Diabetes

Abstract

BackgroundNonalbuminuric renal insufficiency is a unique category of diabetic kidney diseases. The objectives of the study were to evaluate prevalent rate of nonalbuminuric renal insufficiency and to investigate its relationship with previous cardiovascular disease (CVD) event in Korean patients with type 2 diabetes mellitus (T2DM).MethodsLaboratory and clinical data of 1,067 subjects with T2DM were obtained and reviewed. Study subjects were allocated into four subgroups according to the CKD classification. Major CVD events were included with coronary, cerebrovascular, and peripheral vascular events.ResultsNonalbuminuric stage ≥3 CKD group, when compared with albuminuric stage ≥3 CKD group, had shorter diabetic duration, lower concentrations of glycated hemoglobin, high density lipoprotein cholesterol, and high-sensitivity C-reactive protein, lower prevalent rates of retinopathy and previous CVD, and higher rate of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Nonalbuminuric stage ≥3 CKD group showed a greater association with prior CVD events than no CKD group; however, albuminuric stage ≥3 CKD group made addition to increase prevalence of prior CVD events significantly when CKD categories were applied as covariates. Association of prior CVD events, when compared with normal estimated glomerular filtration rate (eGFR) and nonalbuminuria categories, became significant for declined eGFR, which was higher for eGFR of <30 mL/min/1.73 m2, and albuminuria.ConclusionThe results show that subjects with nonalbuminuric stage ≥3 CKD is significantly interrelated with occurrence of prior CVD events than those with normal eGFR with or without albuminuria. Comparing with normal eGFR and nonalbuminuria categories, the combination of increased degree of albuminuria and declined eGFR is becoming significant for the association of prior CVD events.

Nonalbuminuric Renal Insufficiency: Can It Be a Novel Category of Diabetic Nephropathy?

“…This proportion seemed quite low compared with the 39% reported in this paper [9]. This discrepancy might indicate that the subjects of this retrospective study did not represent the patients observed in the real clinical settings.…”

“…In this issue of Endocrinology and Metabolism , Lee et al [9] reported that nonalbuminuric stage ≥3 CKD group (<60 mL/min/1.73 m 2 ) was a significant category of diabetic nephropathy, and that the patients belonging to this category showed higher prevalence of CVD and retinopathy than those with preserved eGFR (≥60 mL/min/1.73 m 2 ). Because this group had shorter diabetic duration than the albuminuric stage ≥3 CKD group, nonalbuminuric stage probably proceed to albuminuric stage.…”

“…This discrepancy might indicate that the subjects of this retrospective study did not represent the patients observed in the real clinical settings. Although the findings of Lee et al [9] are worthwhile from a viewpoint of early detection and intervention of the patients at high risk, a prospective study with a larger number of patients is needed to confirm and establish the significance of nonalbuminuric renal insufficiency.…”

Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”

“…In detail, prevalence was: 40.1% in the Developing Education on Microalbuminuria for Awareness of renal and cardiovascular risk in Diabetes (DEMAND) Study (multinational, MDRD, 2003) [27,28]; 51.8% in the Japan Diabetes Clinical Data Management (JDDM) Study (Japan, MDRD, 2004e2005) [29]; 54.2% in the National Evaluation of the Frequency of Renal Impairment cO-existing with NIDDM (NEFRON) (Australia, MDRD, 2005) [30,31] [38]. Lower prevalence rates were reported in two epidemiological surveys from Korea (23.7%) [39] and US (the Chronic Renal Insufficiency Cohort [CRIC] Study, 28.4%) [40], but patients whose albuminuria status was possibly related to RAS blocker therapy were excluded from these analyses.…”

Articles inEndocrinology and Metabolismin 2016

“…Bae [27] reviewed the cardiovascular safety of diabetic drugs, and Kang and Jung [30] reviewed the cardiovascular effects of glucagon-like peptide-1 receptor agonists. Many articles on the topic of diabetes and obesity were published in the remaining issues of 2016 [313233343536373839404142]. …”