Thailand diabetes registry project: prevalence, characteristics and treatment of patients with diabetic nephropathy.
OBJECTIVE
To identify the prevalence and characteristics of patients with Diabetic Nephropathy (DN) and to evaluate adequacy of glycemic and blood pressure control of these patients in the authors' registry.


METHODS
A cross-sectional, multicenter, hospital-based diabetic registry was carried out in diabetes clinics of 11 tertiary centers in Thailand. DN was defined as the presence of at least two out of three of these symptoms; positive microalbuminuria, positive dipstick proteinuria or creatinine levels equal to or greater than 2 mg/dl. One center that did not perform urine microalbumin measurement was excludedfrom the analysis. Overt nephropathy was defined as the presence of gross proteinuria or renal insufficiency.


RESULTS
The study included 4875 patients (females 63.8%) with a mean (SD) duration ofdiabetes of 12.8 (8.2) years. The prevalence of DN was 42.9% (microalbuminuria 19.7% and overt nephropathy 23.2%). There were 373 (7.7%) patients with renal insufficiency and 24 (0.47%) with end-stage renal disease. By multivariate analysis, factors associated with DN were age, duration of diabetes, male sex, smoking, blood pressure, HbA1c, dyslipidemia and presence of diabetic retinopathy. Prevalence of ischemic heart disease and cerebrovascular disease in patients with DN was 11.5% and 6.6% respectively. Mean (SD) HbA1c in patients with nephropathy was 8.2 (2.6)%. Only 25% of subject had HbA1c of less than 7%, 46% had blood pressure ofmore than 140/90 mmHg and 84% received at least one antihypertensive drug. However, the target blood pressure of less than 130/80 mmHg could be achieved in only 18% of these patients. The mean (SD) number of antihypertensive drugs was 1.7 (1.1). Nearly 60% of patients received either ACE inhibitors or ARBs.


CONCLUSIONS
DN was very common. The overall picture of DN in the present survey suggests the seriousness of the problem and prompts more aggressive intervention.
Ngarmukos
Chardpraorn
C
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. tecng@mahidol.ac.th
Bunnag
Pongamorn
P
Kosachunhanun
Natapong
N
Krittiyawong
Sirinate
S
Leelawatana
Rattana
R
Prathipanawatr
Thongchai
T
Plengvidhya
Nattachet
N
Benjasuratwong
Yupin
Y
Suwanwalaikorn
Sompongse
S
Deerochanawong
Chaicharn
C
Chetthakul
Thanya
T
Mongkolsomlit
Sirima
S
Rawdaree
Petch
P
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016730:Program Development; D012042:Registries; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
D000959:Antihypertensive Agents