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Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (national evaluation of the frequency of renal impairment cO-existing with NIDDM [NEFRON] 11).

Thomas MC, Macisaac RJ, Jerums G, Weekes A, Moran J, Shaw JE, Atkins RC - Diabetes Care (2009)

Bottom Line: RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247).However, its impact may be more significant.New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.

View Article: PubMed Central - PubMed

Affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia. mthomas@baker.edu.au

ABSTRACT
OBJECTIVE Most diabetic patients with impaired renal function have a urinary albumin excretion rate in the normal range. In these patients, the etiology of renal impairment is unclear, and it is also unclear whether this nonalbumunuric renal impairment is unique to diabetes. RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247). RESULTS Of the 23.1% of individuals with type 2 diabetes who had eGFR <60 ml/min per 1.73 m(2) (95% CI 21.8-24.5%), more than half (55%) had a urinary albumin excretion rate that was persistently in the normal range. This rate of renal impairment was predictably higher than that observed in the general population (adjusted odds ratio 1.3, 95% CI 1.1-1.5, P < 0.01) but was solely due to chronic kidney disease associated with albuminuria. In contrast, renal impairment in the absence of albuminuria was less common in those with diabetes than in the general population, independent of sex, ethnicity, and duration of diabetes (0.6, 0.5-0.7, P < 0.001). CONCLUSIONS Nonalbuminuric renal impairment is not more common in those with diabetes. However, its impact may be more significant. New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.

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Age-associated increase in the probability of any renal impairment (——) and renal impairment with albuminuria (– – –) in men (■) and women (♢) with type 2 diabetes from the NEFRON study.
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Figure 1: Age-associated increase in the probability of any renal impairment (——) and renal impairment with albuminuria (– – –) in men (■) and women (♢) with type 2 diabetes from the NEFRON study.

Mentions: In patients with type 2 diabetes presenting to their practitioner, 23.1% had an eGFR <60 ml/min per 1.73 m2 (95% CI 21.8–24.5%). The finding of an eGFR <60 ml/min per 1.73 m2 was more common in diabetic women than in men (adjusted OR 1.8, 95% CI 1.5–2.3, P < 0.001) (Fig. 1). Men with diabetes were more likely to have an eGFR <60 ml/min per 1.73 m2 (1.5, 1.2–1.9, P < 0.001), compared with nondiabetic men from the general population, after adjusting for age, sex, ethnicity, and body surface area (Fig. 2 ). In contrast, women with type 2 diabetes were as likely to have an eGFR <60 ml/min per 1.73 m2 as women from the general population (0.9, 0.8–1.1, P = 0.3). This finding was the same across all age-groups (Fig. 2).


Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (national evaluation of the frequency of renal impairment cO-existing with NIDDM [NEFRON] 11).

Thomas MC, Macisaac RJ, Jerums G, Weekes A, Moran J, Shaw JE, Atkins RC - Diabetes Care (2009)

Age-associated increase in the probability of any renal impairment (——) and renal impairment with albuminuria (– – –) in men (■) and women (♢) with type 2 diabetes from the NEFRON study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713618&req=5

Figure 1: Age-associated increase in the probability of any renal impairment (——) and renal impairment with albuminuria (– – –) in men (■) and women (♢) with type 2 diabetes from the NEFRON study.
Mentions: In patients with type 2 diabetes presenting to their practitioner, 23.1% had an eGFR <60 ml/min per 1.73 m2 (95% CI 21.8–24.5%). The finding of an eGFR <60 ml/min per 1.73 m2 was more common in diabetic women than in men (adjusted OR 1.8, 95% CI 1.5–2.3, P < 0.001) (Fig. 1). Men with diabetes were more likely to have an eGFR <60 ml/min per 1.73 m2 (1.5, 1.2–1.9, P < 0.001), compared with nondiabetic men from the general population, after adjusting for age, sex, ethnicity, and body surface area (Fig. 2 ). In contrast, women with type 2 diabetes were as likely to have an eGFR <60 ml/min per 1.73 m2 as women from the general population (0.9, 0.8–1.1, P = 0.3). This finding was the same across all age-groups (Fig. 2).

Bottom Line: RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247).However, its impact may be more significant.New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.

View Article: PubMed Central - PubMed

Affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia. mthomas@baker.edu.au

ABSTRACT
OBJECTIVE Most diabetic patients with impaired renal function have a urinary albumin excretion rate in the normal range. In these patients, the etiology of renal impairment is unclear, and it is also unclear whether this nonalbumunuric renal impairment is unique to diabetes. RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247). RESULTS Of the 23.1% of individuals with type 2 diabetes who had eGFR <60 ml/min per 1.73 m(2) (95% CI 21.8-24.5%), more than half (55%) had a urinary albumin excretion rate that was persistently in the normal range. This rate of renal impairment was predictably higher than that observed in the general population (adjusted odds ratio 1.3, 95% CI 1.1-1.5, P < 0.01) but was solely due to chronic kidney disease associated with albuminuria. In contrast, renal impairment in the absence of albuminuria was less common in those with diabetes than in the general population, independent of sex, ethnicity, and duration of diabetes (0.6, 0.5-0.7, P < 0.001). CONCLUSIONS Nonalbuminuric renal impairment is not more common in those with diabetes. However, its impact may be more significant. New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.

Show MeSH
Related in: MedlinePlus