Progression of kidney disease in type 2 diabetes - beyond blood pressure control: an observational study.
BACKGROUND
The risk factors for progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) have not been fully elucidated. Although uncontrolled blood pressure (BP) is known to be deleterious, other factors may become more important once BP is treated.


METHODS
All patients seen in the outpatient clinics of our hospital between January 1993 and September 2002 with type 2 DM and clinical evidence of CKD were evaluated. Progression of kidney disease was evaluated by rate of decline of glomerular filtration rate (GFR) as estimated from the simplified MDRD formula. Variables associated with progression in univariate analyses were examined by multivariate analysis to determine the factors independently associated with kidney disease progression.


RESULTS
343 patients (mean age 69 years; all male; 77% Caucasian) were studied. Mean BP, glycated hemoglobin, and serum cholesterol during the study period were 138/72 mmHg, 8.1%, and 4.8 mmol/L, respectively. Mean decline of GFR was 4.5 ml min-1 1.73 m2-1 yr-1 (range -14 to +32). Low initial serum albumin (p < 0.001), black race (p < 0.001), and degree of proteinuria (p = 0.002), but not blood pressure, glycated hemoglobin, or serum cholesterol, were independently associated with progression.


CONCLUSIONS
In a cohort of diabetic patients with CKD in whom mean BP was < 140/80 mmHg, the potentially remediable factors hypoalbuminemia and proteinuria but not blood pressure were independently associated with progression of kidney disease. Further understanding of the relationship between these factors and kidney disease progression may lead to beneficial therapies in such patients.
Department of Medicine Veterans Affairs Hospital Hines, IL and Loyola University Medical Center Maywood, IL, USA. dleehey@lumc.edu
David J
DJ
Leehey
Holly J
HJ
Kramer
Tarek M
TM
Daoud
Maninder P
MP
Chatha
Majd A
MA
Isreb
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002908:Chronic Disease; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology* / Q000503:physiopathology* / Q000652:urine; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011507:Proteinuria / Q000209:etiology