The burden of chronic kidney disease in Australian patients with type 2 diabetes (the NEFRON study)

Abstract

Objective: To estimate the frequency of chronic kidney disease (CKD) in a clinic‐based sample of patients with type 2 diabetes in the setting of Australian primary care. Design, setting and participants: Expressions of interest were invited from all registered general practitioners in Australia: 500 GP investigators were randomly selected from each stratum (state and urban versus rural location), proportional to the census population, and asked to recruit and provide data for 10–15 consecutively presenting adults with type 2 diabetes between April and September 2005. Main outcome measures: Estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 and evidence of kidney damage on urinalysis (eg, microalbuminuria). Results: 348 GP investigators submitted data for 3893 individuals with type 2 diabetes (52% men; median age, 66 years). Almost one in every four patients consulting their GPs had an eGFR < 60 mL/min/1.73 m2 (23.1%; 95% CI, 21.8%–24.5%). More than one in three had an elevated urinary albumin–creatinine ratio (ACR) (34.6%; 95% CI, 33.3%–35.9%). There was an overlap of 10.4% of patients with both an eGFR < 60 mL/min/1.73 m2 and an elevated urinary ACR, meaning that almost one in two patients with type 2 diabetes consulting their GPs (47.1%; 95% CI, 45.8%–48.4%) had CKD. CKD was significantly more common in women, in older people, and in individuals with established macrovascular disease. Conclusion: CKD is a common complication of type 2 diabetes, found in about half of all patients with type 2 diabetes consulting their GPs. Efforts to increase the recognition of CKD will lead to improved care, and possibly survival, of patients with type 2 diabetes.

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”

“…All the surveys conducted in the subsequent years reported a rising prevalence (increasing approximately from 40 to 70%) of the nonalbuminuric phenotype among T2D patients with reduced eGFR, with differences among studies depending also on the geographic area and the formula used for eGFR calculation. 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, 2004MDRD, -2005 [29]; 54.2% in the National Evaluation of the Frequency of Renal Impairment cO-existing with NIDDM (NEFRON) (Australia, MDRD, 2005) [30,31]; 56.6% in the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study (Italy, MDRD, 2006MDRD, -2008 [32]; 61.9% in an analysis of the Swedish National Diabetes Register (Sweden, MDRD, 2007) , but patients whose albuminuria status was possibly related to RAS blocker therapy were excluded from these analyses.…”

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”

“…All the surveys conducted in the subsequent years reported a rising prevalence (increasing approximately from 40 to 70%) of the nonalbuminuric phenotype among T2D patients with reduced eGFR, with differences among studies depending also on the geographic area and the formula used for eGFR calculation. 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.…”

CoQ10 ameliorates mitochondrial dysfunction in diabetic nephropathy through mitophagy

“…Diabetic nephropathy (DN), referred to chronic kidney disease (CKD) caused by diabetes mellitus (Möllsten et al 2007), affects approximately 30% of diabetic patients (Parving et al 2006, Thomas et al 2006, Nathan et al 2009. Patients with DN carry a greater risk for comorbidities, like cardiovascular disease (Gilbertson et al 2005), and indeed, renal dysfunction is a central predictor of allcause mortality (Borch-Johnsen & Kreiner 1987).…”