Incidence of diabetic nephropathy in a population of patients with diabetes mellitus in Slovakia: results of the NEFRITI investigation

Authors: Emil Martinka 1;  Peter Ponťuch 2;  Michaela Mišaníková 1;  Jozef Lacka 3;  Barbara Martinková 1;  Anna Kováčová 1;  Silvia Dókušová 1;  Adrián Okša 4
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, Ľubochňa, primár doc. MUDr. Emil Martinka, PhD. 1;  IV. interná klinika LFUK a UN Bratislava, Nemocnica sv. Cyrila a Metoda, Bratislava, prednosta prof. MUDr. Peter Ponťuch, CSc. 2;  Diabetologická ambulancia, Trnava 3;  Nefrologická ambulancia, Poliklinika Slovenskej zdravotníckej univerzity, Bratislava 4
Published in: Forum Diab 2015; 4(3): 198-207
Category: Main Theme: Review


The aim of the study:
To be evaluated: a) incidence of diabetic nephropathy (DNeF) in a population of patients with DM in Slovakia, b) extent of examination of the kidney function parameters (GFR, albuminuria) used in the evaluation of renal functions and presence of DNeF, c) the proportion of patients based on individual stages of chronic kidney disease (CKD) and albuminuria, d) the incidence of microvascular, macrovascular/cardiovascular diseases and cancers depending on the stage of CKD and intensity of albuminuria, e) the proportion of patients with glomerular filtration rate (GFR) < 60 ml/min/1.73 m2 at normal serum creatinine levels, and f) compare the incidence of DNeF specified in patients‘ records and that of DNeF identified based on clinical and laboratory data (UACR, GF, retinopathy, duration of DM).

Material and methods:
Randomized multicenter epidemiologic investigation using the sample of 1948 patients with diabetes mellitus (117 patients with type 1 diabetes mellitus (T1DM) and 1 831 patients with type 2 diabetes mellitus (T2DM). The centres were chosen in such a manner so as to reach a reasonably even geographic spread of patients on the territory of Slovakia. Albuminuria was detected with turbidimetric methods, the glomerular filtration rate GFR (eGFR) was estimated using a formula CKD-EPI.

(T1DM vs T2DM): Men 51.6% vs 46.5%, aged 44.27 vs 63.85 ± 9.48 years, duration of diabetes 17.57 vs 9.28 ± 7.21 years, HbA1c 8.5 ± 1.7 vs 7.5 ± 1.6 median 7.2% (DCCT), BMI 26.2 ± 7.3 vs 31.5 kg.m2, arterial hypertension 41.8 vs 82.1 %, dyslipidemia 43.7 vs 76.8 % serum creatinine 81.8 ± 77.9 vs 80.3 ± 44.0 umol/l, GFR (MDRD-4) 96.6 ± 25,7 vs 87.2 ± 27.7 ml/min/1.73 m2, UACR 7.1 ± 47.9 vs 8.1 ± 36.0 median 1.14 mg/mmol. The proportion of patients with normal albuminuria (nA), resp. microalbuminuria (miA), resp. macroalbuminuria (maA) amounted to 78.8 %, resp. 18.8 %, resp. 2.4 % in patients with T1DM and 69.1 %, resp. 25.7 %, resp. 5.2 % in patients with DM-2. The proportion of patients based on the stage of CKD was as follows (T1DM vs T2DM): CKD1 60 % vs 42.9 %, CKD2 34.5 % vs 42.8 %. CKD3a 2.61 % vs 9.4 %, CKD3b 1.78 % vs 3.3 %, CKD4 0 % vs 1.2 % and CKD5 0.9 % vs 0.39 %. Based on the records the incidence of DNeF (T1DM vs T2DM) amounted to 25.6 % vs 23 %, incidence of DNeF with macroalbuminuria amounted to 2.4 % vs 5.1 %, incidence of DNeFa possible DNeF established based on the presence of MaA or miA, GFR > 30 ml/min/1.73 m2 regardless of the presence of retinopathy and duration of T1DM amounted to 21.2 % vs 32 % and incidence of DNeF established based on the presence of MaA or miA, GFR > 30 ml/min/1.73 m2, diabetic retinopathy and duration of T1DM > 10 years amounted to 14.1 % vs 12.3 %. The incidence of DNeF in all cases increased in direct proportion to increased duration of diabetes. The incidence of complications of diabetes and cancers progressively increased with the stage of CKD and albuminuria intensity.

The examination of albuminuria or GF in Slovakia covers 90.6 % (71.8 % by UACR), resp. 94 % in patients with T1DM and 92.9 (76.6 % by UACR), resp. 97 % in patients with T2DM. The incidence of DNeF established based on the presence of MaA or miA, GFR > 30 ml/min/1.73 m2, diabetic retinopathy and duration of T1DM > 10 years reached 14.1 % vs 12.3 %. The progression of the CKD stage as well as albuminuria was associated with a progressive increase in the incidence of diabetes complications and cancer. Normal levels of serum creatinine were found in 35.4 % of patients with GFR < 60 ml/min/1.73 m2, particularly in older women.

Key words:
diabetic nephropathy – incidence – UACR – glomerular filtration


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