title: Factors affecting the progression of diabetic nephropathy and its complications: a single-center experience in Saudi Arabia.
abstract: OBJECTIVE
  One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients.
  
  
  METHODS
  Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia.
  
  
  METHODS
  DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 μmol/L; and/or GFR <60 mL/min/1.73m(2) ].
  
  
  RESULTS
  Of 1952 files reviewed, 621 (31.8%) met the criteria for DN, and 294 (47%) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m(2) to 45.1 (24.1) mL/min/1.73m(2) at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3%) patients, with 250 (40.3%) patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m(2) at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy.
  
  
  CONCLUSIONS
  Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years.
authors.affiliation: Department of Medicine, Division of Nephrology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. jwakeel@ksu.edu.sa
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Alwakeel
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Isnani
authors.forename: Abdulkareem
authors.initials: A
authors.lastname: Alsuwaida
authors.forename: Ali
authors.initials: A
authors.lastname: Alharbi
authors.forename: Shaikh Ahmed
authors.initials: SA
authors.lastname: Shaffi
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Almohaya
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Ghonaim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine