Anemia and hypertension are risk factors for both renal prognosis and survival in patients with diabetes mellitus.
BACKGROUND
Diabetic nephrosclerosis is the most common cause of renal failure in the industrialized countries. At the same time, the mortality rate of patients with diabetes mellitus is high.


METHODS
To clarify the factors influencing the prognosis and survival of patients with diabetic nephrosclerosis, we carried out a retrospective follow-up study of 166 cases (age, 55.6 +/- 1.0 years; male/female, 110/56) by simple and multifactorial analyses of clinical data recorded at time of renal biopsy, including survival after diagnosis of diabetic mellitus (months), body mass index (BMI) (kg/m(2)) [body weight/(body height)(2)], age (years), mean blood pressure (mBP) (mmHg) [diastolic BP + (systolic BP - diastolic BP)/3], serum levels of albumin (mg/dl), urea nitrogen (BUN) (mg/dl), serum creatinine (s-Cr) (mg/dl), total cholesterol (mg/dl), triglyceride (mg/dl), and fasting blood sugar (FBS) (mg/dl), hematocrit (%), HbA1c (%), urinary protein secretion (g/day), insulin resistance, BP control (good, <140/90 mmHg or poor, > or =140/90 mmHg) after biopsies, and pathomorphological parameters at the biopsy.


RESULTS
We found a significant association between renal prognosis and several factors, e.g., hypoalbuminemia, anemia, high levels of BUN and s-Cr, hypercholesteremia, hypertriglyceridemia at biopsy, poor control of BP after biopsies, Kimmelstiel-Wilson nodule, and severe glomerular and tubulointerstitial damages at the biopsy. In addition, associations between survival and factors such as low value of BMI, elderly age at the biopsy, and poor control of BP after biopsies were significant. By multivariate analysis we also found a significant association of renal prognosis with anemia, BUN, severe glomerular damage at the biopsy, and poor control of BP after biopsies. At the same time, poor control of BP after biopsies had a significant association with survival. On Kaplan-Meier analysis, anemia at biopsy and hypertension after biopsies are risk factors for both renal prognosis and survival in diabetes mellitus patients.


CONCLUSIONS
Our data strongly suggest that good control of BP after biopsies and anemia at the biopsy play pivotal roles in the prognosis and survival of patients with diabetic glomerulosclerosis.
Sasatomi
Yoshie
Y
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan. sasatomi@fukuoka-u.ac.jp.
Kaneoka
Hidetoshi
H
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Abe
Yasuhiro
Y
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Ishimura
Atunori
A
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Ogahara
Satoru
S
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Murata
Toshiaki
T
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Uesugi
Noriko
N
Department of Pathology, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Takebayashi
Shigeo
S
Department of Pathology, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Iwasaki
Hiroshi
H
Department of Pathology, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
Saito
Takao
T
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Fukuoka, 814-0180, Japan.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D001706:Biopsy; D001794:Blood Pressure / Q000502:physiology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult