Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database.

Packham DK, Alves TP, Dwyer JP, Atkins R, de Zeeuw D, Cooper M, Shahinfar S, Lewis JB, Lambers Heerspink HJ
Am J Kidney Dis. 2012 59 (1): 75-83

PMID: 22051245 · DOI:10.1053/j.ajkd.2011.09.017

BACKGROUND - Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial.

STUDY DESIGN - Retrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]).

SETTING & PARTICIPANTS - 3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria.

INTERVENTION - Angiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials).

OUTCOMES & MEASUREMENTS - Incidence rates of ESRD, cardiovascular death, and all-cause mortality.

RESULTS - Mean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline.

LIMITATIONS - All participants were included in a prospective clinical trial.

CONCLUSIONS - Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.

Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (12)

Cardiovascular Diseases Databases, Factual Diabetes Mellitus, Type 2 Diabetic Nephropathies Female Humans Incidence Kidney Failure, Chronic Male Middle Aged Proteinuria Retrospective Studies

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