Prevalence of subnormal glomerular filtration rate in patients with diabetes mellitus


Cite item

Full Text

Abstract

Aim. To evaluate prevalence of subnormal glomerular filtration rate (GFR) in diabetes mellitus (DM) patients with reference to albuminuria level. Material and methods. GFR by MDRD and urine excretion of protein/albumin were estimated in 851 diabetic patients (473 with type 1 DM and 378 with type 2 DM). Results. Normoalbuminuria (NAU), microalbuminuria (MAU) and proteinuria were detected in 54, 16 and 30% type 1 diabetics, respectively; 77% had subnormal GFR, in NAU 8.3% had GFR decline (<60 ml/min) corresponding to stage III-IV chronic disease of the kidneys. In MAU the latter was present in 16.4%, in proteinuria - in 62.8%. Type 2 diabetics had NAU in 33.6% cases, MAU - in 17.7%, proteinuria - in 48.7%. Subnormal GFR <60 ml/min was found in 40% cases with NAU and MAU. Most patients with proteinuria had chronic disease of the kidneys of stage III-V. In a normal creatinine concentration in blood serum subnormal GFR<60 ml/min was observed in type 1 DM in 7.6, in type 2 DM - in 33% cases. Conclusion. Prevalence of subnormal GFR in diabetic patients with NAU and MAU is rather high. This necessitates wide introduction of this index in screening, follow-up and classification of renal damage severity in DM as well as estimation of albuminuria/proteinuria.

Full Text

Распространенность снижения скорости клубочковой фильтрации у больных сахарным диабетом. - Цель исследования. Оценить распространенность снижения скорости клубочковой фильтрации (СКФ) у больных сахарным диабетом (СД) в зависимости от уровня альбуминурии. Материалы и методы. У 851 пациента с СД (473 - СД 1-го типа и 378 - СД 2-го типа) определены расчетная СКФ по уравнению MDRD и экскреция белка/альбумина с мочой. Результаты. У 54% пациентов с СД 1-го типа выявлена нормоальбуминурия (НАУ), у 16% - микроальбуминурия (МАУ), у 30% - явная протеинурия. У 77% больных выявлена та или иная степень снижения СКФ, причем при НАУ у 8,3% обнаружено снижение СКФ (< 60 мл/мин), соответствующее III-IVстадии ХБП. При МАУ III-IV стадии ХБП обнаружены в 16,4% случаев, а при явной протеинурии - в 62,8%. У пациентов с СД 2-го типа НАУ выявлена в 33,6% случаев, МАУ - в 17,7%, а явная протеинурия - в 48,7%. Снижение СКФ < 60 мл/мин обнаружено более чем у 40% пациентов как при НАУ, так и при МАУ. У пациентов с явной протеинурией в большинстве случаев отмечена III-V стадия ХБП. При нормальной концентрации креатинина сыворотки крови снижение СКФ < 60 мл/мин наблюдалось у пациентов с СД 1-го типа в 7,6% случаев, а у пациентов с СД 2-го типа - в 33%. Заключение. Распространенность снижения СКФ в популяции больных СД с НАУ и МАУ достаточно высока, что указывает на необходимость широкого внедрения оценки этого показателя при скрининге, динамическом наблюдении и классификации тяжести поражения почек при СД наряду с определением уровня альбуминурии/протеинурии.
×

References

  1. Ritz Е., Rychlik I., Locatelli F., Halimi S. End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions. Am. J. Kidney Dis. 1999; 34: 795-808.
  2. USDRS 2004 annual data report. Am. J. Kidney Dis. 2005; 45: 8-280.
  3. Mogensen С. E., Christensen C., Vittinghus E. The stages in diabetic renal disease with emphasis on the stage of incipient diabetic nephropathy. Diabetes 1983; 32: 64-78.
  4. Mogensen С. E., Schmitz O. The diabetic kidney: from hyperfiltration and microalbuminuria to end-stage renal failure. Med. Clin. N. Am. 1988; 72: 1465-1492.
  5. National Kidney Foundation KD: Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am. J. Kidney Dis. 2002; 39 (suppl. 1): S1-S266.
  6. Levey A. S., Bosch J. P., Lewis J. B. et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction indication. Modification of Diet in Renal Disease Study Group. Ann. Intern. Med. 1999; 130 (6): 461-470.
  7. www.kidney.org/professionals/KDOQI/guidelines_ckd/p5_ lab_g5.htm
  8. Adler A. I., Stevens R. J., Manley S. E. et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003; 63: 225-232.
  9. So W. Y., Kong A. P., Ma R. C. et al. Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients. Diabet. Care 2006; 29 (9): 2046-2052.
  10. Nag S., Bilous R., Kelly W. et al. All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years' data from the South Tees Diabetes Mortality Study. Diabet. Med. 2007; 24 (1): 10-17.
  11. Knobler H., Zomtzki Т., Vered S. et al. Reduced glomerular filtration rate in asymptomatic diabetic patients: predictor of increased risk for cardiac events independent of albuminuria. J. Am. Coll. Cardiol. 2004; 44 (11): 2142-2148.
  12. Смирнов А. В., Каюков И. Г., Есаян А. М. и др. Превентивный подход в современной нефрологии. Нефрология 2004; 8 (3): 7-14.
  13. Смирнов А. В., Добронравов В. А., Каюков И. Г. Кардиоренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9 (3): 7-15.
  14. Majunath G., Tighionart Н., Ibrahim Н. et al. Level of kidney function as a risk factors for atherosclerotic cardiovascular outcomes in the community. J. Am. Coll. Cardiol. 2003; 41: 47-55.
  15. Henry R. M., Kostense P. J., Bos G. et al. Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int. 2002; 62: 1402-1407.
  16. Nitsch D., Dietrich D. F., von Eckardstein A. et al. Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA Study. Nephrol. Dial. Transplant. 2006; 21 (4): 935-944.
  17. Segura J., Campo C., Ruilope L. M. Effect of proteinuria and glomerular filtration rate on cardiovascular risk in essential hypertension. Kidney Int. 2004; suppl. 92: S45-S49.
  18. Tsalamandris C., Allen T. J., Gilbert R. E. et al. Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 1994; 43: 649-655.
  19. MacIsaac R. J., Tsalamandris C., Panagiotopoulos S. et al. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabet. Care 2004; 27: 195-200.
  20. Osterby R. Glomerular structural changes in type 1 (insulin-dependent) diabetes mellitus: causes, consequences, and prevention. Diabetologia 1992; 35 (9): 803-812.
  21. Steffes М. W., Bilous R. W., Sutherland D. Е., Mauer S. M. Cell and matrix components of the glomerular mesangium in type I diabetes. Diabetes 1992; 41: 679-684.
  22. Mogensen С. E. Reduced glomerular filtration rate and cardiovascular damage in diabetes: A key role for abnormal albuminuria. Acta Diabetol. 1992; 29: 201-213.
  23. Torbjornsdotter Т. В., Perrin N. E., Jaremko G. A., Berg U. B. Widening of foot processes in normoalbuminuric adolescents with type 1 diabetes. Pediatr. Nephrol. 2005; 20: 750-758.
  24. Bjorn S. F., Bangstad H. J., Hanssen K. F. et al. Glomerular epithelial foot processes and filtration slits in IDDM patients. Diabetologia 1995; 38: 1197-1204.
  25. Ellis E. N., Steffes M. W., Chavers В., Mauer S. M. Observations of glomerular epithelial cell structure in patients with type I diabetes mellitus. Kidney Int. 1987; 32: 736-741.
  26. Toyoda M., Najafian В., Kim Y. et al. Podocyte detachment and reduced glomerular capillary endothelial fenestration in human type 1 diabetic nephropathy. Diabetes 2007; 56 (8): 2155-2160.
  27. Steinke J. M., Sinaiko A. R., Kramer M. S. et al. The early natural history of nephropathy in type 1 diabetes. III: Predictors of 5-year urinary albumin excretion rate patterns in initially normoalbuminuric patients. Diabetes 2005; 54: 2121-2164.
  28. Steffes M. W., Schmidt D., McCrery R., Basgen J. M. Glomerular cell number in normal subjects and in type 1 diabetic patients. Kidney Int. 2001; 59: 2104-2113.
  29. Caramori M. L., Fioretto P., Mauer M. Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: an indicator of more advanced glomerular lesions. Diabetes 2003; 52: 1036-1040.
  30. Kramer H. J., Nguyen Q. D., Curhan G. Hsu C. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. J. A. M. A. 2003; 289: 3273-3277.
  31. Middleton R. J., Foley R. N., Hegarty J. et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol. Dial. Transplant. 2006; 21 (1): 88-92.
  32. Silveiro S. P., Friedman R., de Azevedo M. J. et al. Five-year prospective study of glomerular filtration rate and albumin excretion rate in normofiltering and hyperfiltering normoalbuminuric NIDDM patients. Diabet. Care 1996; 19 (2): 171-174.
  33. Nosadini R., Velussi M., Brocco E. et al. Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate. Diabetes 2000; 49: 476-484.
  34. Christensen P. K., Gall M. A., Parving H. H. Course of glomerular filtration rate in albuminuric type 2 diabetic patients with or without diabetic glomerulopathy. Diabet. Care 2000; 23 (suppl. 2): B14-B20.
  35. Gambara V., Mecca G., Remuzzi G., Bertani T. Heterogeneous nature of renal lesions in type II diabetes. J. Am. Soc. Nephrol. 1993; 3: 1458-1466.
  36. Fioretto P., Mauer M., Brocco E. et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia 1996; 39: 1569-1576.
  37. Rychlik I., Fliser D., Ritz E. Non-diabetic renal disease in type 2 DM. In: Ritz E., Rychlik I., eds. Nephropathy in type 2 diabetes. Oxford: Oxford University Press; 1999. 7-88.
  38. National Kidney Foundation: KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am. J. Kidney Dis. 2007; 49: S1-S180.
  39. Walser M. Assessing renal function from creatinine measurements in adults with chronic renal failure. Am. J. Kidney. Dis. 1998; 32 (1): 23-31.
  40. Kong A. P. S., So W. Y., Szeto С. C. et al. Assessment of glomerular filtration rate in addition to albuminuria is important in managing type II diabetes. Kidney Int. 2006; 69 (2): 383-387.
  41. American Diabetes Association. Standards of medical care in diabetes. Diabet. Care 2004; 27 (suppl. 1): S15-S21.
  42. Levey A. S., Greene Т., Kusek J. W. et al. A simplified equation to predict glomerular filtration rate from serum creatinine. [Abstract]. J. Am. Soc. Nephrol. 2000; 11: A0828.
  43. Rigalleau V., Lasseur C., Perlemoine C. et al. Estimation of glomerular filtration rate in diabetic subjects Cockcroft formula or modification of diet in renal disease study equation? Diabet. Care 2005; 28: 838-843.
  44. Poggio E. D., Wang X, Greene T. et al. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J. Am. Soc. Nephrol. 2005; 16: 459-466.
  45. Froissard M., Rossert J., Jacquot C. et al. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J. Am. Soc. Nephrol. 2005; 16: 763-773.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2008 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies