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. 2005 Jun 28:6:8.
doi: 10.1186/1471-2369-6-8.

Progression of kidney disease in type 2 diabetes - beyond blood pressure control: an observational study

David J Leehey  1 , Holly J Kramer, Tarek M Daoud, Maninder P Chatha, Majd A Isreb
Affiliations

Progression of kidney disease in type 2 diabetes - beyond blood pressure control: an observational study

David J Leehey et al. BMC Nephrol. .

Abstract

Background: The risk factors for progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) have not been fully elucidated. Although uncontrolled blood pressure (BP) is known to be deleterious, other factors may become more important once BP is treated.

Methods: All patients seen in the outpatient clinics of our hospital between January 1993 and September 2002 with type 2 DM and clinical evidence of CKD were evaluated. Progression of kidney disease was evaluated by rate of decline of glomerular filtration rate (GFR) as estimated from the simplified MDRD formula. Variables associated with progression in univariate analyses were examined by multivariate analysis to determine the factors independently associated with kidney disease progression.

Results: 343 patients (mean age 69 years; all male; 77% Caucasian) were studied. Mean BP, glycated hemoglobin, and serum cholesterol during the study period were 138/72 mmHg, 8.1%, and 4.8 mmol/L, respectively. Mean decline of GFR was 4.5 ml min-1 1.73 m2-1 yr-1 (range -14 to +32). Low initial serum albumin (p < 0.001), black race (p < 0.001), and degree of proteinuria (p = 0.002), but not blood pressure, glycated hemoglobin, or serum cholesterol, were independently associated with progression.

Conclusion: In a cohort of diabetic patients with CKD in whom mean BP was < 140/80 mmHg, the potentially remediable factors hypoalbuminemia and proteinuria but not blood pressure were independently associated with progression of kidney disease. Further understanding of the relationship between these factors and kidney disease progression may lead to beneficial therapies in such patients.

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Figures

Figure 1
Figure 1
Relationship between degree of proteinuria and rate of GFR decline (1 = mild proteinuria; 2 = moderate proteinuria; 3= heavy proteinuria; see text for definitions)
Figure 2
Figure 2
Relationship between initial serum albumin level and rate of GFR decline.
Figure 3
Figure 3
Relationship between mean systolic blood pressure during the study period and rate of GFR decline.
Figure 4
Figure 4
Relationship between mean diastolic blood pressure during the study period and rate of GFR decline.
See this image and copyright information in PMC

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