The epidemiology of diabetic nephropathy

Pugh, Jacqueline A.

doi:10.1002/dmr.5610050701

Cited by 20 publications

(8 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The finding that renal disease was not an underlying cause of death in any patient in this NIDDM cohort agrees with previous observations showing renal disease mortality to be an uncommon outcome in white NIDDM patients (5,(7)(8)(9). This is in contrast to the findings in nonwhite cohorts (35).…”

Section: Discussionsupporting

confidence: 91%

Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

et al. 1992

View full text Add to dashboard Cite

Retrospective studies of patients with non-insulin-dependent diabetes mellitus (NIDDM) have suggested that microalbuminuria predicts early all-cause (mainly cardiovascular) mortality independently of arterial blood pressure. These findings have not been confirmed in prospective studies, and it is not known whether the predictive power of microalbuminuria is independent of other major cardiovascular risk factors. During 1985-1987, we examined a representative group of 141 nonproteinuric patients with NIDDM for the prevalence of coronary heart disease and several of its established and putative risk factors, including raised urinary albumin excretion (UAE) rate. Thirty-six patients had microalbuminuria (UAE 20-200 micrograms/min), and 105 had normal UAE (less than 20 micrograms/min). At follow-up, an average of 3.4 yr later, 14 patients had died. There was a highly significant excess mortality (chiefly from cardiovascular disease) among those with microalbuminuria (28%) compared to those without microalbuminuria (4%, P less than 0.001). In univariate survival analysis, significant predictors of all-cause mortality included microalbuminuria (P less than 0.001), hypercholesterolemia (P less than 0.01), hypertriglyceridemia (P less than 0.05), and preexisting coronary heart disease (P less than 0.05). The predictive power of microalbuminuria persisted after adjustment for the effects of other major risk factors (P less than 0.05). We conclude that microalbuminuria is a significant risk marker for mortality in NIDDM, independent of the other risk factors examined. Its presence can be regarded as an index of increased cardiovascular vulnerability and a signal for vigorous efforts at correction of known risk factors.

show abstract

Section: Discussionsupporting

confidence: 91%

Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

et al. 1992

View full text Add to dashboard Cite

show abstract

“…IDDM conferred a 4.1 times higher risk of this complication when compared to NIDDM. Although these data showed borderline significance (P = 0.057), it is possible to confirm the existence of an association between IDDM and increased risk of DN, which is also supported by other studies (32). As far as ethnicity is concerned, a preponderance of white individuals is found in the São Paulo population (33) and the same pattern was demonstrable in the two groups studied.…”

Section: Discussionsupporting

confidence: 80%

“…Also, patients with DN frequently have neurological disturbances and, in fact, some investigators have suggested a causal role for autonomic neuropathy in the genesis of renal injury (40). Macrovascular disease is seen as the main cause of mortality in diabetic subjects, in particular NIDDM patients (1), in contrast to the incidence of DN which is much lower than in IDDM (32). In both groups studied, the great majority of the patients evaluated had NIDDM, which could limit the demonstration of an association of ESRF with macrovascular disease by regression analysis.…”

Section: Discussionmentioning

confidence: 99%

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

Ferreira¹,

Pinto²

1997

Braz J Med Biol Res

View full text Add to dashboard Cite

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

show abstract

“…There is a large body of literature indicating that the degree and duration of hyperglycemia are the principal risk factors for the microvascular complications of diabetes (15)(16)(17)(18)(19)(20). These, however, are not the principal risk factors for macrovascular complications.…”

Section: Risk Factors For Macrovascular Complications Of Diabetesmentioning

confidence: 99%

Dyslipidemia in type II Diabetes: Implications for Therapeutic Intervention

Stern

Haffner

1991

Diabetes Care

View full text Add to dashboard Cite

Cardiovascular disease, and in particular ischemic heart disease, is the principal cause of morbidity, functional disability, and mortality in patients with non-insulin-dependent (type II) diabetes. The main risk factors for the macrovascular complications of diabetes are dyslipidemia, hypertension, and cigarette smoking. Although degree of hyperglycemia is a risk factor for microvascular complications, it is not a prominent risk factor for macrovascular complications. Nevertheless, there are theoretical reasons for believing that glycemic control could lower cardiovascular risk. For example, glycemic control may both improve clearance and suppress hepatic overproduction of very-low-density lipoprotein. Moreover, there is direct empirical evidence that improved glycemic control can favorably alter lipid profiles in type II diabetic patients. Despite this, the only clinical trial that has assessed cardiovascular mortality as an end point in diabetic subjects (i.e., the University Group Diabetes Program) failed to demonstrate a benefit of glycemic control. In this study, the insulin-variable group, which achieved sustained glycemic control relative to the placebo group, had essentially the same cardiovascular mortality as the latter group. All of the conventional lipid-lowering agents have been shown to produce favorable changes in lipid profiles in diabetic subjects. However, the optimum regimen remains to be defined. Metabolic differences between diabetic and nondiabetic subjects mean that the optimum lipid-lowering regimens for the two categories of patients may differ. For example, nicotinic acid, which is a powerful lipid-altering drug, may worsen glucose intolerance. The characteristic lipid abnormalities in type II diabetic subjects are hypertriglyceridemia and low high-density lipoprotein cholesterol, not hypercholesterolemia. Although the role of hypertriglyceridemia as a cardiovascular risk factor in the general population has been questioned, there is evidence that this lipid abnormality may play a stronger role in diabetic subjects. For all of the above reasons, there is an urgent need for large-scale clinical trials assessing cardiovascular end points and testing various strategies of improving lipid profiles in diabetic subjects, particularly given the fact that all of the current generation of lipid-lowering trials have systematically excluded diabetic patients.

show abstract

The epidemiology of diabetic nephropathy

Cited by 20 publications

References 87 publications

Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

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

Dyslipidemia in type II Diabetes: Implications for Therapeutic Intervention

Contact Info

Product

Resources

About