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

David K. Packham, Tahira P. Alves, Jamie P Dwyer, Robert Atkins, Dick de Zeeuw, Mark Cooper, Shahnaz Shahinfar, Julia B Lewis, Hiddo J. Lambers Heerspink

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108 Citations (Scopus)

Abstract

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. 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 NonInsulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]). 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. Angiotensin receptor blocker versus nonangiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials). Incidence rates of ESRD, cardiovascular death, and all-cause mortality. 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. All participants were included in a prospective clinical trial. 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.

Original languageEnglish
Pages (from-to)75-83
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume59
Issue number1
DOIs
Publication statusPublished - Jan 2012

Keywords

  • cardiovascular mortality
  • Diabetes Mellitus Treatment for Renal Insufficiency Consortium (DIAMETRIC)
  • end-stage renal disease
  • Type 2 diabetic nephropathy

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