title: Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database.
abstract: BACKGROUND
  Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial.
  
  
  METHODS
  Retrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]).
  
  
  METHODS
  3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria.
  
  
  METHODS
  Angiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials).
  
  
  METHODS
  Incidence rates of ESRD, cardiovascular death, and all-cause mortality.
  
  
  RESULTS
  Mean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline.
  
  
  CONCLUSIONS
  All participants were included in a prospective clinical trial.
  
  
  CONCLUSIONS
  Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.
authors: Melbourne Renal Research Group, Royal Melbourne Hospital, Nephrology and Austin Hospital, Nephrology, Melbourne, Australia.
authors: David K
authors: DK
authors: Packham
authors: Tahira P
authors: TP
authors: Alves
authors: Jamie P
authors: JP
authors: Dwyer
authors: Robert
authors: R
authors: Atkins
authors: Dick
authors: D
authors: de Zeeuw
authors: Mark
authors: M
authors: Cooper
authors: Shahnaz
authors: S
authors: Shahinfar
authors: Julia B
authors: JB
authors: Lewis
authors: Hiddo J
authors: HJ
authors: Lambers Heerspink
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications*; D012189:Retrospective Studies