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

David J Leehey1, Holly J Kramer, Tarek M Daoud

  • 1Department of Medicine Veterans Affairs Hospital Hines, IL and Loyola University Medical Center Maywood, IL, USA. dleehey@lumc.edu

BMC Nephrology
|June 30, 2005
PubMed
Abstract

Insights

In type 2 diabetes mellitus patients with chronic kidney disease, low albumin and proteinuria, not blood pressure, predict kidney disease progression. These findings highlight potential therapeutic targets for managing diabetic kidney disease.

Area of Science:

  • Nephrology
  • Endocrinology
  • Diabetology

Background:

  • Risk factors for chronic kidney disease (CKD) progression in type 2 diabetes mellitus (DM) require further elucidation.
  • While uncontrolled blood pressure (BP) is known to harm kidneys, other factors may be more critical once BP is managed.

Purpose of the Study:

  • To identify factors independently associated with the progression of kidney disease in patients with type 2 diabetes and CKD.
  • To investigate the role of blood pressure, glycated hemoglobin, and serum cholesterol in CKD progression after controlling for BP.

Main Methods:

  • Retrospective evaluation of 343 patients with type 2 DM and CKD between 1993 and 2002.
  • Glomerular filtration rate (GFR) decline rate estimated using the MDRD formula to assess kidney disease progression.
  • Univariate and multivariate analyses to determine independent predictors of CKD progression.

Main Results:

  • Low initial serum albumin, black race, and degree of proteinuria were independently associated with CKD progression (p < 0.001, p < 0.001, and p = 0.002, respectively).
  • Blood pressure, glycated hemoglobin, and serum cholesterol levels were not independently associated with kidney disease progression in this cohort.
  • Mean GFR decline was 4.5 ml/min/1.73 m²/yr, with significant variability.

Conclusions:

  • In type 2 diabetic patients with CKD and controlled BP (<140/80 mmHg), hypoalbuminemia and proteinuria are significant independent predictors of kidney disease progression.
  • These potentially modifiable factors, hypoalbuminemia and proteinuria, warrant further investigation for therapeutic interventions in diabetic kidney disease.

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