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The clinical course of renal function in NIDDM patients with normo- and microalbuminuria
S Nielsen1, A Schmitz, M Rehling
1Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Denmark.
Objectives:
To assess the clinical course of renal function in relation to risk factors in NIDDM patients with normo- and microalbuminuria.
Design:
Prospective clinical study.
Setting:
Outpatient diabetic clinic.
Subjects:
Thirty-two NIDDM patients with normo- or microalbuminuria followed for (mean (range)) 5.5 (3.3-7.5) years.
Main Outcome Measures:
Glomerular filtration rate, urinary albumin excretion rate, blood pressure, lipids, glycaemic control.
Results:
The mean rate of decline of glomerular filtration rate was -1.2 +/- 2.3 (mean +/- SD) (95% confidence intervals: -2.0--0.3) mL min-1 1.73 m-2 year-1 (p = 0.009). A considerable interindividual variation was observed (range -6.7 to + 3.4 mL min-1 1.73 m-2 year-1). No difference was found between normo- and microalbuminuric patients (-1.2 +/- 0.5 vs. -1.0 +/- 0.7 mL min-1 1.73 m-2 year-1) or between patients with and without anti-hypertensive treatment (-1.7 +/- 0.7 vs. -0.7 +/- 0.4 mL min-1 1.73 m-2 year-1). By multiple linear regression analysis the fall rate of glomerular filtration was determined by the mean glomerular filtration rate level (p = 0.036). Analysis of patients without antihypertensive treatment revealed that urinary albumin excretion rate and HbA1c levels significantly determined the fall rate of glomerular filtration (P < 0.001 and = 0.014).
Conclusions:
The average decline in renal function of these normo- and microalbuminuric NIDDM patients was not increased as compared to the age related fall rate of healthy subjects but varied markedly. Low glomerular filtration rate is associated with a higher fall rate. In patients without antihypertensive treatment higher urinary albumin excretion rate, and poorer glycaemic control are factors associated with an increased fall rate of glomerular filtration.