Risk factors of diabetic nephropathy progression in patients with a long history of diabetic mellitus as shown by a retrospective analysis
Shestakova, M.V.; Koshel', L.V.; Vagodin, V.A.; Dedov, I.I.
Terapevticheskii Arkhiv 78(5): 60-64
2006
ISSN/ISBN: 0040-3660 PMID: 16889052 Document Number: 601966
Aim. To ascertain prognostic factors defining the risk of progression of diabetic nephropathy (DN) in patients with diabetes mellitus (DM) type 1 and 2 suffering from DM over 20 years.Material and methods. A one-stage comparative trial studied 141 patients with DM type 1 and 149 patients with DM type 2 with DN of different severity and 20 year history of the disease. The follow-up study covered 34 CD-1 patients and 45 CD-2 patients with normo-, micro- and macroalbuminuria. The groups were made by the principle case-control. The control group consisted of 24 patients with DM-1 and 19 patients with DM-2 having stable renal function, the case group consisted of 10 and 26 patients, respectively, with DN progression. A total duration of the follow-up was 6 years. The end point of the analysis was chronic renal failure (CRF).Results. Multivariate regression analysis has shown that the following risk factors of microalbuminuria in DM-1 and DM-2 are independent: the level of HbA1c (RR 3,1 and 2.7, respectively) and duration of arterial hypertension (RR 2.1 and 2.0, respectively); proteinuria - HbA1c (RR 4.4 and 3.4, respectively), systolic blood pressure (RR 3.4 and 3.1, respectively), CRF - systolic blood pressure (RR 5.0 and 4.5, respectively), triglycerides (RR 2.8 and 4.9, respectively) and hemoglobin (RR 3.3 and 5.3, respectively). IN DM-2 other risk factors of CRF were male sex (RR 2.0), family history of hypertension (RR 3.8) and 24-h proteinuria > 2 g (RR 6.7).Conclusion. Inadequate compensation of carbohydrate metabolism (HbA1c), arterial hypertension and dyslipidemia are main risk factors of MA U and its progression to proteinuria in DM patients. In progression of DN to CRF main risk factors are hypertension, dyslipidemia and severity of anemia.