Abstract
ObjectiveTo evaluate the incidence rate of Chronic Kidney Disease (CKD) stage 3-5 (persistent decreased kidney function under 60 mL/min per 1.73 m2) among patients with type 2 diabetes over five years, to identify the risk factors associated with CKD, and develop a risk table to predict five-year CKD stage 3-5 risk stratification for clinical use.DesignThe MADIABETES Study is a prospective cohort study of 3,443 outpatients with type 2 diabetes mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain).ResultsThe cumulative incidence of CKD stage 3-5 at five-years was 10.23% (95% CI = 9.12–11.44) and the incidence density was 2.07 (95% CI = 1.83–2.33) cases per 1,000 patient-months or 2.48 (95% CI = 2.19–2.79) cases per 100 patient-years. The highest hazard ratio (HR) for developing CKD stage 3-5 was albuminuria ≥300 mg/g (HR = 4.57; 95% CI= 2.46-8.48). Furthermore, other variables with a high HR were age over 74 years (HR = 3.20; 95% CI = 2.13–4.81), a history of Hypertension (HR = 2.02; 95% CI = 1.42–2.89), Myocardial Infarction (HR= 1.72; 95% IC= 1.25–2.37), Dyslipidemia (HR = 1.68; 95% CI 1.30–2.17), duration of diabetes mellitus ≥ 10 years (HR = 1.46; 95% CI = 1.14-1.88) and Systolic Blood Pressure >149 mmHg (HR = 1.52; 95% CI = 1.02–2.24).ConclusionsAfter a five-year follow-up, the cumulative incidence of CKD is concordant with rates described in Spain and other countries. Albuminuria ≥ 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5). Blood Pressure, lipid and albuminuria control could reduce CKD incidence of CKD in patients with T2DM.
Highlights
The highest hazard ratio (HR) for developing Chronic Kidney Disease (CKD) stage 3-5 was albuminuria !300 mg/g (HR = 4.57; 95% Confidence Intervals (CI)= 2.46-8.48)
Albuminuria ! 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5)
Diabetic nephropathy develops in approximately 40% of all type 2 diabetes mellitus (T2DM) patients and is characterized by persistent albuminuria, elevated blood pressure (BP) and a progressive decline in kidney function leading toward end-stage renal disease
Summary
Diabetic nephropathy develops in approximately 40% of all type 2 diabetes mellitus (T2DM) patients and is characterized by persistent albuminuria, elevated blood pressure (BP) and a progressive decline in kidney function leading toward end-stage renal disease. These patients have a high risk of cardiovascular disease, which further increases with deteriorating renal function [1]. The estimated GFR (eGFR) has proven to be a significant, independent risk factor for cardiovascular morbidity and mortality in patients with T2DM [3, 4]. To our knowledge, there are not enough studies analyzing the incidence of sustained impaired eGFR and its association with risk factors in Southern Europe [5,6]
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