Skip Navigation



NDT Advance Access published online on September 17, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp475
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Lorenzo, V.
Right arrow Articles by Torres, A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lorenzo, V.
Right arrow Articles by Torres, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Similar renal decline in diabetic and non-diabetic patients with comparable levels of albuminuria

Victor Lorenzo1, Ramon Saracho2, Javier Zamora3, Margarita Rufino1 and Armando Torres4

1 Nephrology Section, Hospital Universitario de Canarias, Santa Cruz de Tenerife, La Laguna 2 Nephrology Division, Hospital de Santiago, Vitoria, Alava 3 Biostatistic Unit, Hospital Ramon y Cajal, Madrid 4 Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife. Fundación Reina Sofía de Investigación, Spain

Correspondence and offprint requests to: Victor Lorenzo; E-mail: vls243{at}gmail.com



  Abstract

Background. Diabetes is the main cause of ESRD, and albuminuria is a major determinant of adverse renal outcome. Likewise, albuminuria is an intermediate risk factor of chronic kidney disease (CKD) progression in diabetic patients. Our aim was to compare the rate of renal decline in diabetic and non-diabetic CKD patients (GFR < 50 ml/min) with comparable levels of albuminuria.

Methods. In this observational study, 333 patients (age 67 ± 15 years, 46% diabetics) were included during a 7.5-year period. The mean follow-up was 30 ± 18 months (range 4–79). The influence of study variables was evaluated applying a time-dependent Cox model and slope-based outcome using a linear regression model.

Results. The diabetes condition was associated with adverse outcome in univariate analysis, and after adjusting for age, sex and systolic blood pressure. However, when controlling for albuminuria (a time-dependent covariate), diabetes did not show any association with outcome. In addition, the mean slope of renal decline was similar in diabetic and non-diabetic patients when controlling for albuminuria. The urinary albumin–creatinine ratio was a robust predictor of poor outcome in uni- and multivariate models. In the diabetic group, time-varying glycosilated haemoglobin did not influence renal outcome in the Cox model, and time-varying albuminuria remained a strong predictor of outcome.

Conclusions. Diabetic patients have a poorer renal outcome, but at comparable levels of albuminuria renal decline is similar in diabetic and non-diabetic patients. Albuminuria is a risk factor for renal decline, and the main target to delay progression in patients, diabetics or non-diabetics, with moderate to advanced CKD.

Keywords: albuminuria; chronic kidney disease; diabetes; renal disease progression

Received for publication: 29. 3.09
Accepted in revised form: 18. 8.09


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.