title: Risk factors for development and progression of diabetic kidney disease and treatment patterns among diabetic siblings of patients with diabetic kidney disease.
abstract: BACKGROUND
  Diabetic siblings of patients with treated kidney failure from diabetic kidney disease are at a 5-fold increased risk of future kidney failure. The objective of this study is to define risk factors for kidney disease, clinical features, and treatment patterns in diabetic siblings of patients with diabetes with diabetic kidney disease.
  
  
  METHODS
  Cross-sectional analysis using data collected from diabetic siblings of patients with diabetic kidney disease.
  
  
  METHODS
  295 diabetic siblings with mean diabetes duration of 15 years from within a 400-mile radius of Cleveland, OH, or Winston-Salem, NC.
  
  
  METHODS
  Demographic data, diabetes duration, blood pressure (BP), access to health care, and diabetes control.
  
  
  RESULTS
  Albuminuria (defined as urinary albumin-creatinine ratio >or= 30 mg/g, with microalbuminuria with albumin of 30 to 300 mg/g and macroalbuminuria with albumin > 300 mg/g), renal function.
  
  
  METHODS
  BP, urinary albumin-creatinine ratio, serum creatinine, glycosylated hemoglobin (HbA(1c)), estimated glomerular filtration rate.
  
  
  RESULTS
  Mean diabetes duration was 14.6 +/- 10.6 years. Albuminuria was present in 46% of participants. In individuals with diabetes duration of 11 to 15 years, 25% had microalbuminuria and 18.2% had macroalbuminuria. Despite a positive family history and a high prevalence of albuminuria, only 35.3% of participants had a target systolic BP less than 130 mm Hg. HbA(1c) levels were 7% or greater in 57.4% of patients, and 26.4% of participants were smokers. Only 58% of patients received angiotensin-converting enzyme inhibitors or receptor blockers. In microalbuminuric participants, HbA(1c) level was greater than 10% in 28.6% versus 13.3% in those without albuminuria (P = 0.02).
  
  
  CONCLUSIONS
  A control group of diabetic siblings without a family history of diabetic kidney disease was not obtained.
  
  
  CONCLUSIONS
  Diabetic siblings of patients with diabetic kidney disease have a high prevalence of albuminuria and poor glycemic and BP control. Targeting these high-risk individuals for interventions to improve their BP and blood glucose control might prevent or slow the progression of diabetic kidney disease.
authors.affiliation: Section on Nephrology, Wake Forest University School of Medicine, Winston Salem, NC 27106, USA. ableyer@wfubmc.edu
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bleyer
authors.forename: John R
authors.initials: JR
authors.lastname: Sedor
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.forename: Alicia
authors.initials: A
authors.lastname: O'Brien
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.forename: Joni
authors.initials: J
authors.lastname: Graley
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schelling
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D035781:Siblings