Normoalbuminuric Renal-Insufficient Diabetic Patients
Normoalbuminuric Renal-Insufficient Diabetic Patients A lower-risk group Vincent Rigalleau , MD, PHD 1 , Catherine Lasseur , MD 2 , Christelle Raffaitin , MD 1 , Marie-Christine Beauvieux , PD, PHD 3 , Nicole Barthe , PD 4 , Philippe Chauveau , MD 2 , Christian Combe , MD, PHD 2 and Henri Gin , MD,...
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| Veröffentlicht in: | Diabetes care Jg. 30; H. 8; S. 2034 - 2039 |
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| Hauptverfasser: | , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
American Diabetes Association
01.08.2007
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| ISSN: | 0149-5992, 1935-5548 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | Normoalbuminuric Renal-Insufficient Diabetic Patients
A lower-risk group
Vincent Rigalleau , MD, PHD 1 ,
Catherine Lasseur , MD 2 ,
Christelle Raffaitin , MD 1 ,
Marie-Christine Beauvieux , PD, PHD 3 ,
Nicole Barthe , PD 4 ,
Philippe Chauveau , MD 2 ,
Christian Combe , MD, PHD 2 and
Henri Gin , MD, PHD 1
1 Department of Nutrition-Diabétologie, Hôpital Haut-Lévêque, Pessac, France
2 Department of Nephrologie, Université Victor Segalen-Bordeaux 2, Hôpital Pellegrin, Bordeaux, France
3 Department of Biochimie, Hôpital Haut-Lévêque, Pessac, France
4 Department of Médecine Nucléaire, Hôpital Pellegrin, Bordeaux, France
Address correspondence and reprint requests to Vincent Rigalleau, Nutrition-Diabétologie, Hôpital Haut-Lévêque, Avenue de
Magellan, 33600 Pessac, France. E-mail: vincent.rigalleau{at}wanadoo.fr
Abstract
OBJECTIVE —About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations
(albumin excretion rate >30 mg/24 h or estimated glomerular filtration rate [GFR] <60 ml/min per 1.73 m 2 ) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?
RESEARCH DESIGN AND METHODS —A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) <60 ml/min
per 1.73 m 2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 ± 11 months.
RESULTS —The mean MDRD e-GFR (41.3 ± 13.1 ml/min per 1.73 m 2 ) did not significantly differ from the i-GFR (45.6 ± 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR
did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 ± 27 vs.
160 ± 71 μmol/l, P < 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic
retinopathy, and their HDL cholesterol and hemoglobin were higher ( P < 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric:
10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P < 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the
AER increased in the microalbuminuric patients ( P < 0.05), and the sCr increased in the macroalbuminuric patients ( P < 0.01).
CONCLUSIONS —Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR
below 60 ml/min per 1.73 m 2 do really have a GFR below 60 ml/min per 1.73 m 2 . However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or
death is lower.
AER, albumin excretion rate
CKD, chronic kidney disease
e-GFR, estimated glomerular filtration rate
GFR, glomerular filtration rate
MDRD, modification of diet in renal disease
Footnotes
Published ahead of print at http://care.diabetesjournals.org on 7 May 2007. DOI: 10.2337/dc07-0140.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
Accepted April 29, 2007.
Received January 23, 2007.
DIABETES CARE |
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| ISSN: | 0149-5992 1935-5548 |
| DOI: | 10.2337/dc07-0140 |