Early intensive treatment improves outcomes in patients with glomerular hyperfiltration and type 2 diabetes.
OBJECTIVE
Approximately 24-40% of patients with type 2 diabetes mellitus (T2DM) develop kidney damage. Our objective was to evaluate the long-term evolution of renal function using isotopic determination of GFR and urinary albumin excretion (UAE) in patients with T2DM undergoing intensive treatment for renal and cardiovascular risk factors.


METHODS
This was a single-center, prospective study of 201 patients with T2DM and UAE who initiated intensive treatment. They were followed for 17.2±6.5 years. Patients were divided into three groups, according to renal function: 167(85.6%) had stable renal function, 16(8.2%) had creatinine levels that doubled and 12(6.2%) began renal replacement therapy (RRT). We performed periodic isotopic determinations of GFR using (125)I-iothalamate.


RESULTS
There were significant differences between the three groups with respect to age, duration of T2DM at baseline, years of follow-up in the study and systolic blood pressure, serum creatinine, isotopic GFR, and UAE at baseline. Renal function evolution slopes were -1.55mL/min/1.73m(2)/year in patients with stable creatinine, -2.49mL/min/1.73m(2)/year in those with doubled creatinine, and -8.16mL/min/1.73m(2)/year in those requiring RRT. We also found that differences in renal events were determined by delayed initiation of intensive treatment.


CONCLUSIONS
Patients with glomerular hyperfiltration who were undergoing treatment with renin angiotensin aldosterone system blockers exhibited a better evolution in renal function, possibly because these patients initiated intensive treatment earlier. Although diabetic nephropathy is associated with classic risk factors, early initiation of intensive treatment should be a priority in order to prevent worsening renal function.
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, Badalona, Spain. Electronic address: m.troyasaborido@gmail.com.
Maria-Isabel
MI
Troya
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, Badalona, Spain.
Josep
J
Bonet
Department of Endocrinology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Isabel
I
Salinas
Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Ferran
F
Torres
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Jordi
J
Bonal
Department of Endocrinology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Anna
A
Sanmartí
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, Badalona, Spain.
Ramón
R
Romero
D000419:Albuminuria / Q000209:etiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000503:physiopathology; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D061345:Early Medical Intervention; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007483:Iothalamic Acid / Q000493:pharmacokinetics; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012084:Renin-Angiotensin System / Q000187:drug effects; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007457:Iodine Radioisotopes; D000451:Mineralocorticoid Receptor Antagonists; D007483:Iothalamic Acid; D003404:Creatinine
Early intensive treatment; Filtrado glomerular isotópico; Glomerular hyperfiltration; Hiperfiltración glomerular; Isotopic glomerular filtration rate; Long-term renal survival; Nefropatía diabética tipo 2; Supervivencia renal a largo plazo; Tratamiento intensivo precoz; Type 2 diabetic nephropathy