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The clinical course of renal function in NIDDM patients with normo‐ and microalbuminuria
Author(s) -
NIELSEN S.,
SCHMITZ A.,
REHLING M.,
MOGENSEN C. E.
Publication year - 1997
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1997.93107000.x
Subject(s) - microalbuminuria , medicine , renal function , urology , confidence interval , endocrinology , blood pressure , prospective cohort study , excretion
Objectives. To assess the clinical course of renal function in relation to risk factors in NIDDM patients with normo‐ and microalbuminuria. Design. Prospective clinical study. Setting. Outpatient diabetic clinic. Subjects. Thirty‐two NIDDM patients with normo‐ or microalbuminuria followed for (mean (range)) 5.5 (3.3–7.5) years. Main outcome measures. Glomerular filtration rate, urinary albumin excretion rate, blood pressure, lipids, glycaemic control. Results. The mean rate of decline of glomerular filtration rate was −1.2±2.3 (mean±SD) (95% confidence intervals: −2.0–−0.3) mL min −1 1.73 m −2 year −1 ( p =0.009). A considerable interindividual variation was observed (range −6.7 to +3.4 mL min −1 1.73 m −2 year −1 ). No difference was found between normo‐ and microalbuminuric patients (−1.2±0.5 vs. −1.0±0.7 mL min −1 1.73 m −2 year −1 ) or between patients with and without antihypertensive treatment (−1.7±0.7 vs. −0.7±0.4 mL min −1 1.73 m −2 year −1 ). By multiple linear regression analysis the fall rate of glomerular filtration was determined by the mean glomerular filtration rate level ( p =0.036). Analysis of patients without antihypertensive treatment revealed that urinary albumin excretion rate and HbA 1c levels significantly determined the fall rate of glomerular filtration ( P <0.001 and=0.014). Conclusions. The average decline in renal function of these normo‐ and microalbuminuric NIDDM patients was not increased as compared to the age related fall rate of healthy subjects but varied markedly. Low glomerular filtration rate is associated with a higher fall rate. In patients without antihypertensive treatment higher urinary albumin excretion rate, and poorer glycaemic control are factors associated with an increased fall rate of glomerular filtration.