title: Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: a 12 years observational study.
abstract: OBJECTIVE
  Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre.
  
  
  METHODS
  Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted.
  
  
  RESULTS
  During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA 1 c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA 1 c and mean values of HbA 1 c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria.
  
  
  CONCLUSIONS
  Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.
authors.affiliation: M.V. Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education & Training in Diabetes, Chennai, India. drvijay@mvdiabetes.com
authors.forename: Vijay
authors.initials: V
authors.lastname: Viswanathan
authors.forename: Priyanka
authors.initials: P
authors.lastname: Tilak
authors.forename: Satyavani
authors.initials: S
authors.lastname: Kumpatla
mesh_terms: D000367:Age Factors; D001786:Blood Glucose; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000209:etiology*; D006442:Glycated Hemoglobin; D006801:Humans; D008137:Longitudinal Studies; D011507:Proteinuria / Q000453:epidemiology* / Q000209:etiology; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D014508:Urea / Q000097:blood
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D014280:Triglycerides; D014508:Urea; C517652:hemoglobin A1c protein, human