Clinical significance of nonalbuminuric renal impairment in type 2 diabetes

被引：255

作者：

Penno, Giuseppe ^{[1
]}

Solini, Anna ^{[2
]}

Bonora, Enzo ^{[3
]}

Fondelli, Cecilia ^{[4
]}

Orsi, Emanuela ^{[5
]}

Zerbini, Gianpaolo ^{[6
]}

Trevisan, Roberto ^{[7
]}

Vedovato, Monica ^{[8
]}

Gruden, Gabriella ^{[9
]}

Cavalot, Franco ^{[10
]}

Cignarelli, Mauro ^{[11
]}

Laviola, Luigi ^{[12
]}

Morano, Susanna ^{[13
]}

Nicolucci, Antonio ^{[15
]}

Pugliese, Giuseppe ^{[14
]}

机构：

[1] Univ Pisa, Dept Endocrinol & Metab, Pisa, Italy

[2] Univ Pisa, Dept Internal Med, Pisa, Italy

[3] Univ Verona, Div Endocrinol & Metab Dis, I-37100 Verona, Italy

[4] Univ Siena, Diabet Unit, Dept Internal Med, I-53100 Siena, Italy

[5] Osped Maggiore Policlin, Fdn IRCCS Ca Granda, Dept Med Sci, Endocrinol & Diabet Unit, Milan, Italy

[6] Ist Sci San Raffaele, Complicat Diabet Unit, Div Metab & Cardiovasc Sci, I-20132 Milan, Italy

[7] AO Osped Riuniti, Diabet Unit, Hosp Bergamo, Bergamo, Italy

[8] Univ Padua, Dept Clin & Expt Med, Padua, Italy

[9] Univ Turin, Dept Internal Med, Turin, Italy

[10] Univ Turin, Dept Clin & Biol Sci, Unit Internal Med, Orbassano, Italy

[11] Univ Foggia, Dept Med Sci, Unit Endocrinol & Metab Dis, Foggia, Italy

[12] Univ Bari, Sect Internal Med Endocrinol Androl & Metab Dis, Dept Emergency & Organ Transplantat, Bari, Italy

[13] Univ Roma La Sapienza, Dept Internal Med & Med Specialties, Rome, Italy

[14] Univ Roma La Sapienza, Dept Clin & Mol Med, Rome, Italy

[15] Consorzio Mario Negri Sud, Dept Clin Pharmacol & Epidemiol, Chieti, Italy

来源：

JOURNAL OF HYPERTENSION | 2011年 / 29卷 / 09期

关键词：

albuminuria; cardiovascular disease; GFR; type; 2; diabetes; GLOMERULAR-FILTRATION-RATE; CHRONIC KIDNEY-DISEASE; SERUM CREATININE; INSUFFICIENCY; ALBUMINURIA; MICROALBUMINURIA; RECOMMENDATIONS; RETINOPATHY; ABSENCE; RISK;

D O I：

10.1097/HJH.0b013e3283495cd6

中图分类号：

R6 [外科学];

学科分类号：

100210 [外科学];

摘要：

Objective In type 2 diabetes, prevalence of nonalbuminuric renal impairment is increasing worldwide, though its clinical significance remains unclear. This large-cohort study aimed at evaluating the association of this phenotype with cardiovascular risk factors and other complications. Methods Type 2 diabetic patients from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study (n=15773), visiting consecutively 19 hospital-based Diabetes Clinics in years 2007-2008, were examined. Serum creatinine was assessed by the Jaffe method; albuminuria was measured by immunonephelometry or immunoturbidimetry. Results Of patients with renal impairment, as identified by an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m(2), 56.6% were normoalbuminuric, 30.8% were microalbuminuric, and 12.6% were macroalbuminuric. Percentages were similar when GFR was estimated using the more accurate Chronic Kidney Disease Epidemiology Collaboration equation instead of the simplified Modification of Diet in Renal Disease formula, and were independent of age, thus indicating that the increasing prevalence of this phenotype does not reflects misclassification of elderly patients. Nonalbuminuric renal impairment was not associated with HbA(1c) and correlated less strongly with retinopathy and hypertension than albuminuria, either alone or associated with reduced eGFR. It was associated with a higher prevalence of cardiovascular disease (CVD) than albuminuria alone, but lower than albuminuric renal impairment. Female sex correlated with nonalbuminuric renal impairment and male sex with the albuminuric forms. Conclusions These data show that type 2 diabetic patients with nonalbuminuric renal impairment exhibit distinct clinical features, suggesting predominance of macroangiopathy as underlying renal pathology, and that this phenotype is associated with significant CVD burden. J Hypertens 29:1802-1809 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

引用

页码：1802 / 1809

页数：8

共 26 条

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