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Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study.

Abstract

OBJECTIVE

To evaluate putative risk factors for the development of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) in patients with non-insulin dependent diabetes.

DESIGN

Prospective, observational study of a cohort of white, non-insulin dependent diabetic patients followed for a median period of 5.8 years.

SETTING

Outpatient clinic in tertiary referral centre.

SUBJECTS

191 patients aged under 66 years with non-insulin dependent diabetes and normoalbuminuria (urinary albumin excretion rate < 30 mg/24 h) who attended the clinic during 1987.

MAIN OUTCOME MEASURES

Incipient and overt diabetic nephropathy.

RESULTS

Fifteen patients were lost to follow up. Thirty six of the 176 remaining developed persistent microalbuminuria (30-299 mg/24 h in two out of three consecutive 24 hour urine collections) and five developed persistent macroalbuminuria (> or = mg/24 h in two out of three consecutive collections) during follow up. The five year cumulative incidence of incipient diabetic nephropathy was 23% (95% confidence interval 17% to 30%). Cox's multiple stepwise regression analysis revealed the following risk factors for the development of incipient or overt diabetic nephropathy: increased baseline log urinary albumin excretion rate (relative risk 11.1 (3.4 to 35.9); P < 0.0001); male sex (2.6 (1.2 to 5.4); P < 0.02); presence of retinopathy (2.4 (1.3 to 4.7); P < 0.01); increased serum cholesterol concentration (1.4 (1.1 to 1.7); P < 0.01); haemoglobin A1c concentration (1.2 (1.0 to 1.4); P < 0.05); and age (1.07 (1.02 to 1.12); P < 0.01). Known duration of diabetes, body mass index, arterial blood pressure, serum creatinine concentration, pre-existing coronary heart disease, and history of smoking were not risk factors.

CONCLUSION

Several potentially modifiable risk factors predict the development of incipient and overt diabetic nephropathy in normoalbuminuric patients with non-insulin dependent diabetes.

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  • Authors+Show Affiliations

    ,

    Steno Diabetes Center, Gentofte, Denmark.

    , ,

    Source

    BMJ (Clinical research ed.) 314:7083 1997 Mar 15 pg 783-8

    MeSH

    Adult
    Aged
    Albuminuria
    Coronary Disease
    Diabetes Mellitus, Type 2
    Diabetic Nephropathies
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Prospective Studies
    Regression Analysis
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    9080995

    Citation

    Gall, M A., et al. "Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Patients With Non-insulin Dependent Diabetes Mellitus: Prospective, Observational Study." BMJ (Clinical Research Ed.), vol. 314, no. 7083, 1997, pp. 783-8.
    Gall MA, Hougaard P, Borch-Johnsen K, et al. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ. 1997;314(7083):783-8.
    Gall, M. A., Hougaard, P., Borch-Johnsen, K., & Parving, H. H. (1997). Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ (Clinical Research Ed.), 314(7083), pp. 783-8.
    Gall MA, et al. Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Patients With Non-insulin Dependent Diabetes Mellitus: Prospective, Observational Study. BMJ. 1997 Mar 15;314(7083):783-8. PubMed PMID: 9080995.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. AU - Gall,M A, AU - Hougaard,P, AU - Borch-Johnsen,K, AU - Parving,H H, PY - 1997/3/15/pubmed PY - 1997/3/15/medline PY - 1997/3/15/entrez SP - 783 EP - 8 JF - BMJ (Clinical research ed.) JO - BMJ VL - 314 IS - 7083 N2 - OBJECTIVE: To evaluate putative risk factors for the development of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) in patients with non-insulin dependent diabetes. DESIGN: Prospective, observational study of a cohort of white, non-insulin dependent diabetic patients followed for a median period of 5.8 years. SETTING: Outpatient clinic in tertiary referral centre. SUBJECTS: 191 patients aged under 66 years with non-insulin dependent diabetes and normoalbuminuria (urinary albumin excretion rate < 30 mg/24 h) who attended the clinic during 1987. MAIN OUTCOME MEASURES: Incipient and overt diabetic nephropathy. RESULTS: Fifteen patients were lost to follow up. Thirty six of the 176 remaining developed persistent microalbuminuria (30-299 mg/24 h in two out of three consecutive 24 hour urine collections) and five developed persistent macroalbuminuria (> or = mg/24 h in two out of three consecutive collections) during follow up. The five year cumulative incidence of incipient diabetic nephropathy was 23% (95% confidence interval 17% to 30%). Cox's multiple stepwise regression analysis revealed the following risk factors for the development of incipient or overt diabetic nephropathy: increased baseline log urinary albumin excretion rate (relative risk 11.1 (3.4 to 35.9); P < 0.0001); male sex (2.6 (1.2 to 5.4); P < 0.02); presence of retinopathy (2.4 (1.3 to 4.7); P < 0.01); increased serum cholesterol concentration (1.4 (1.1 to 1.7); P < 0.01); haemoglobin A1c concentration (1.2 (1.0 to 1.4); P < 0.05); and age (1.07 (1.02 to 1.12); P < 0.01). Known duration of diabetes, body mass index, arterial blood pressure, serum creatinine concentration, pre-existing coronary heart disease, and history of smoking were not risk factors. CONCLUSION: Several potentially modifiable risk factors predict the development of incipient and overt diabetic nephropathy in normoalbuminuric patients with non-insulin dependent diabetes. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/9080995/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=9080995 DB - PRIME DP - Unbound Medicine ER -