NDT Advance Access published online on July 17, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp349
Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS)
1 Department of Endocrinology and Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus 2 Department of Endocrinology and Metabolism, Fudan University Affiliated Zhongshan Hospital 3 Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Renji Hospital 4 Caoyang Health Center 5 Huayang Health Center, Shanghai, China
Correspondence and offprint requests to: Weiping Jia; E-mail: wpjia{at}sjtu.edu.cn
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Abstract |
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Background. Diabetes is a major risk factor for the development of kidney disease. We aimed to determine the prevalence of albuminuria and chronic kidney disease (CKD) in Chinese subjects with diabetes and pre-diabetes and the risk factors for kidney disease.
Methods. An urban community-based sample of 3714 adults in Shanghai was classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes. The estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (ACR) were applied to designate renal function and albuminuria, respectively. Binary logistic regression was performed to analyse the contribution of risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR.
Results. The prevalence of microalbuminuria, macroalbuminuria and CKD in subjects with diabetes was 22.8%, 3.4% and 29.6%, respectively, which was significantly higher than that in non-diabetes subjects. After adjustment for age, the odds ratio of hypertension for albuminuria and renal insufficiency (eGFR <60 mL/min/1.73 m2, stages 3–5 of CKD) were 1.23 (P = 0.000) and 2.55 (P = 0.000). Diabetes and cardiovascular disease (CVD) both increased the risk for albuminuria significantly, with the odds ratio of 1.22 (P = 0.04) and 1.36 (P = 0.006), respectively. Diabetes and CVD were not independent risk factor for renal insufficiency. Although the worsening trends of eGFR are similar in diabetes and IGR subjects, IGR was not a significant risk factor for albuminuria and renal insufficiency.
Conclusion. Screening for albuminuria and eGFR is highly recommended for older patients with diabetes, hypertension and CVD to prevent end-stage kidney disease.
Keywords: albuminuria; chronic kidney disease; diabetes; pre-diabetes
Received for publication: 23.11.08
Accepted in revised form: 24. 6.09