Titre du document / Document title

Low incidence of end-stage renal disease and chronic renal failure in type 2 diabetes: A 10-year prospective study

Auteur(s) / Author(s)

BRUNO Graziella ⁽¹⁾ ; BIGGERI Annibale ⁽²⁾ ; MERLETTI Franco ⁽³⁾ ; BARGERO Giuseppe ⁽⁴⁾ ; FERRERO Stefania ⁽¹⁾ ; PAGANO Gianfranco ⁽¹⁾ ; CAVALLO PERIN Paolo ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Internal Medicine, Turin University, Torino, ITALIE
⁽²⁾ Department of Statistics G. Parenti, Florence University, Florence, ITALIE
⁽³⁾ Unit of Cancer Epidemiology, Turin University, Torino, ITALIE
⁽⁴⁾ Santo Spirito Hospital, Casale Monferrato, Alessandria, ITALIE

Résumé / Abstract

OBJECTIVE - Data on the incidence of end-stage renal disease (ESRD) and chronic renal failure from population-based studies in Caucasian type 2 diabetic patients are lacking. To provide such data, a population-based cohort of type 2 diabetic patients was identified in Casale Monferrato, Italy, and prospectively examined from 1991 to 2001. RESEARCH DESIGN AND METHODS - During the follow-up period, patients were regularly examined with centralized measurements of plasma creatinine and HbA_1c. Independent predictors of progression to renal events were identified with multivariate Cox proportional hazards modeling, with sex, age, and individual follow-up time as confounders. RESULTS - We followed 1,408 of 1,540 (91.4%) patients (average follow-up time 6.7 years, range 0.011-11.1); 10 new cases of ESRD and 72 of chronic renal failure (plasma values of creatinine ≥2.0 mg/dl) were identified, giving incidence rates/1,000 person-years of 1.04 (95% Cl 0.56-1.94) and 7.63 (6.06-9.61), respectively. Cumulative risks for chronic renal failure adjusted for competing mortality were 6.1 and 9.3% after 20 and 30 years from diagnosis of diabetes, respectively. Incidence rates and cumulative risks of chronic renal failure defined by plasma creatinine values >1.5 mg/dl increased to 13.1/1,000 person-years, 8.6 and 14.8%, respectively. In Cox regression analysis, predictors of progression (after adjustment for confounders) were hypertension (P = 0.078), diastolic blood pressure (P = 0.034), BMI (P = 0.03), and albumin excretion rate (AER) (P < 0.0001). CONCLUSIONS - We provide evidence that the individual risk of ESRD and chronic renal failure is low. AER and diastolic blood pressure are independent predictors of progression. These findings underline the relevance of primary prevention to reduce the number of diabetic patients with ESRD.

Revue / Journal Title

Diabetes care   ISSN 0149-5992   CODEN DICAD2 

Source / Source

2003, vol. 26, n^o8, pp. 2353-2358 [6 page(s) (article)] (20 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Diabetes Association, Alexandria, VA, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Cardiovascular disease ; Kidney disease ; Urinary system disease ; Endocrinopathy ; Europe ; Predictive factor ; Prospective ; Hypertension ; Albumin ; Diastole ; Arterial pressure ; Italy ; Incidence ; Follow up study ; Chronic ; Terminal stage ; Renal failure ; Complication ; Human ; Type 2 diabetes ;

Mots-clés français / French Keywords

Appareil circulatoire pathologie ; Rein pathologie ; Appareil urinaire pathologie ; Endocrinopathie ; Europe ; Facteur prédictif ; Prospective ; Hypertension artérielle ; Albumine ; Diastole ; Pression artérielle ; Italie ; Incidence ; Etude longitudinale ; Chronique ; Stade terminal ; Insuffisance rénale ; Complication ; Homme ; Diabète type 2 ;

Mots-clés espagnols / Spanish Keywords

Aparato circulatorio patología ; Riñón patología ; Aparato urinario patología ; Endocrinopatía ; Europa ; Factor predictivo ; Prospectiva ; Hipertensión arterial ; Albúmina ; Diástole ; Presión arterial ; Italia ; Incidencia ; Estudio longitudinal ; Crónico ; Estadio terminal ; Insuficiencia renal ; Complicación ; Hombre ; Diabetes de tipo 2 ;

Localisation / Location

INIST-CNRS, Cote INIST : 18054, 35400011255313.0210