Vascular disease and survival in patients with type 2 diabetes and nephropathy

Abstract

Diabetic nephropathy in patients with type 2 diabetes is associated with progressive renal failure and accelerated cardiovascular disease. We performed a retrospective review of 126 patients who presented to a combined diabetic-renal clinic between 1989 and 1999. We analysed the prevalence of vascular disease, cardiovascular risk factors and the use of cardioprotective drugs. Patient survival was analysed and poor prognostic indicators were identified. At referral, 68% had documented vascular disease, mean blood pressure (BP) was 162/84 mmHg, HbA1C 8.2% and cholesterol 6.2 mmol/L. Significant improvements were achieved in BP and cholesterol. Median patient survival from time of referral was 61 months. Seventy-three percent of deaths were a consequence of vascular disease. Factors predicting death at referral were low haemoglobin, low creatinine clearance, high albumin: creatinine ratio, lack of use of aspirin and female sex. These data highlight the extent of vascular disease and poor survival in patients with type 2 diabetes and nephropathy. The importance of early cardioprotection is emphasised.