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

Overview

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.

Results:
(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.

Summary:
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


Sources

1. Molitch ME, DeFronzo RA, Franz MJ. American Diabetes Association. Nephropathy in Diabetes. Diabetes Care 2004; 27(Suppl 1): S79-S83.

2. American Diabetes Association. Standards of medical care in diabetes – 2015. Diabetes Care 2015; 38(Suppl 1): S58-S66.

3. Adler AI, Stevens RJ, Manley SE et al.: Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63(1): 225–232.

4. Andersen AR, Christiansen JS, Andersen JK et al.: Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983; 25(6): 496–501.

5. Astor BC, Hallan SI, Miller ER 3rd et al. Glomerular Filtration Rate, Albuminuria, and Risk of Cardiovascular and All-Cause Mortality in the US Population. Am J Epidemiol 2008; 167(10): 1226–1234.

6. de Boer IH, Rue TC, Hall YN et al. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA 2011; 305(24): 2532–2539.

7. Carrero JJ, de Mutsert R, Axelsson J et al. Sex differences in the impact of diabetes on mortality in chronic dialysis patients. Nephrol Dial Transplant 2011; 26(1): 270–276.

8. Collins AJ, Li S, Gilbertson DT et al. Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int 2003; (87): S24–S31.

9. Davis TM, Brown SG, Jacobs IG et al. Determinants of Severe Hypoglycemia Complicating Type 2 Diabetes: The Fremantle Diabetes Study. J Clin Endocrinol Metab 2010; 95(5): 2240–2247.

10. Finne P, Reunanen A, Stenman S et al. Incience of end-stage renal disease in patients with type 1 diabetes. JAMA 2005; 294(14): 1782–1787.

11. Groop PH, Thomas MC, Moran JL et al. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes 2009; 58(7); 1651–1658.

12. Hovind P, Tarnow L, Rossing P et al. Predictors of the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ 2004; 328(7448): 1105.

13. Huang ES, Liu JY, Moffet HH et al. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care 2011; 34(6):1329–1336.

14. Chaturvedi N, Bandinelli S, Mangili R et al. Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold. Kidney Int 2001; 60(1): 219–227.

15. Chen J. Diabetic Nephropathy: Scope of the Problem In: Lerma EV, Batuman V (eds). Diabetes and Kidney Disease. Springer Science+Business Media: New York 2014. Dostupné z DOI: <http://dx.doi.org/10.1007/978–1-4939–0793–9_2>.

16. Inaba M, Okuno S, Kumeda Y et al. Glycated Albumin Is a Better Glycemic Indicator than Glycated Hemoglobin Values in Hemodialysis Patients with Diabetes: Effect of Anemia and Erythropoietin Injection. J Am Soc Nephrol 2007; 18(3): 896–903.

17. Kraft S, Lazaridis E, Qiu C et al. Screening and treatment of diabetic nephropathy by primary care physicians. J Gen Intern Med 1999; 14(2): 88–97.

18. Martinka E, Pontuch P. The prevalence of diabetic nephropathy in patients with type 2 diabetes mellitus in Slovakia: the NEFRITI Study. EASD Stockholm, Sweden, 2015. ePoster A1117. Dostupné z WWW: <http://www.easdvirtualmeeting.org/resources/the-prevalence-of-diabetic-nephropathy-in-patients-with-type-2-diabetes-mellitus-in-slovakia-the-nefriti-study--3>.

19. Martinka E. III. Renálne parametre. In: NEFRITI. Randomizovaný multicentrický prieskum zameraný na výskyt diabetickej nefropatie a jej štádií u pacientov s diabetes mellitus na Slovensku. Dostupné z WWW: <http://www.euni.cz/files/fileUploader/download/eds_sk/nefriti_3.pdf>.

20. Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 1984; 311(2): 89–93.

21. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310(6): 356–360.

22. Nakao T, Matsumoto H, Okada Tet al. Influence of erythropoietin treatment on hemoglobin A1c levels in patients with chronic renal failure on hemodialysis. Intern Med 1998; 37(10): 826–830.

23. Činnosť diabetologických ambulancií v SR 2013. Činnosť nefrologických ambulancií. Národné centrum zdravotníckych informácií. Edícia zdravotnícka štatistika. NCZI 2014; (14). Dostupné z WWW: <http://www.nczisk.sk/Documents/publikacie/2013/zs1411.pdf>.

24. Oomichi T, Emoto M, Tabata T et al. Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study. Diabetes Care 2006; 29(7): 1496–1500.

25. Okša A, Ponťuch P, Spustová V et al. Diabetická nefropatia – diagnostika, prevencia a liečba. Odporúčané postupy Slovenskej nefrologickej spoločnosti a Slovenskej diabetologickej spoločnosti. Diabetes a obezita 2012; 12(24): 99 a 101–107. Dostupné z WWW: <http://www.diaslovakia.sk/contentData/0227/Diabeticka_nefropatia_SNS_a_SDS.pdf>.

26. Parving H, Lewis J, Ravid M et al. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 2006; 69(11): 2057–2063.

27. Parving HH, Oxenbøll B, Svendsen PA et al. Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion. Acta Endocrinol (Copenh) 1982; 100(4): 550–555.

28. Ponťuch P, Hozlárová M, Bučková E et al. Skupina DIANEBA. Prevalencia diabetickej nefropatie u diabetikov 1. typu v Bratislave. Diabetes a obezita 2002; 2(3): 37–41.

29. Ponťuch P, Lištiaková D, Černá K et al. Výskyt mikroalbuminúrie, klinickej proteinúrie a artériovej hypertenzie u diabetikov 2. typu na Slovensku. Diabetes a obezita 2004; 4: 41–48.

30. Schernthaner G, Stummvoll KH, Muller MM. Glycosylated haemoglobin in chronic renal failure. Lancet 1979; 1(8119): 774.

31. Unnikrishnan RI, Rema M, Pradeepa R et al. Prevalence and risk factors of diabetic nephropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45). Diabetes Care 2007; 30(8): 2019–2024.

32. Valmadrid CT, Klein R, Moss SE et al. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000; 160(8): 1093–1100.

33. Viberti GC, Hill RD, Jarrett RJ et al. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1982; 1(8287):1430–1432.

34. Wong TY, Shankar A, Klein R et al. Retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in people with type 1 diabetes. Diabetes 2004; 53(1):179–184.

35. Yokoyama H, Sone H, Oishi M et al. Japan Diabetes Clinical Data Management Study Group. Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant 2009; 24(4):1212–1219.

36. Young BA, Maynard C, Boyko EJ. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabetes Care 2003; 26(8):2392–2399.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account