CONTEXT: Kidney disease in type 2 diabetes mellitus (DM) is more heterogeneous than in type 1 DM. Reduced glomerular filtration rate (GFR) among individuals with type 2 DM may not always be due to classic diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy. OBJECTIVE: To determine the prevalence of chronic renal insufficiency (CRI), defined as a GFR less than 60 mL/min per 1.73 m2 body surface area (BSA) in the absence of microalbuminuria or macroalbuminuria and diabetic retinopathy among adults with type 2 DM. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of adults aged 40 years or older with type 2 DM in the Third National Health and Nutrition Examination Survey, a probability sample of the total civilian US noninstitutionalized population conducted from 1988-1994. MAIN OUTCOME MEASURES: The GFR per 1.73 m2 BSA, calculated with serum creatinine, urea nitrogen, and serum albumin levels using the Modification of Diet in Renal Disease Study prediction equation; albuminuria, assessed using spot urine albumin/creatinine ratio; and presence of retinopathy, determined with fundus photography. RESULTS: Overall, 13% (sampled n = 171) of adults with type 2 DM (n = 1197) had CRI with a population estimate of 1.1 million. Among these adults with CRI, diabetic retinopathy was noted in 28% (n = 58), while the frequencies of microalbuminuria and macroalbuminuria were 45% (n = 64) and 19% (n = 47), respectively. Retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were both absent in 30% (n = 51) of adults with type 2 DM and CRI. The population estimate of adults with type 2 DM and CRI in the absence of diabetic retinopathy or albuminuria was approximately 0.3 million. CONCLUSIONS: A substantial burden of CRI among persons with type 2 DM in the United States is likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis. Approaches to screening renal disease in the type 2 DM population should incorporate assessment of GFR in addition to monitoring urine albumin excretion and funduscopic changes to ensure that individuals with type 2 DM and CRI not due to diabetic glomerulosclerosis will receive appropriate intervention.
CONTEXT: Kidney disease in type 2 diabetes mellitus (DM) is more heterogeneous than in type 1 DM. Reduced glomerular filtration rate (GFR) among individuals with type 2 DM may not always be due to classic diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy. OBJECTIVE: To determine the prevalence of chronic renal insufficiency (CRI), defined as a GFR less than 60 mL/min per 1.73 m2 body surface area (BSA) in the absence of microalbuminuria or macroalbuminuria and diabetic retinopathy among adults with type 2 DM. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of adults aged 40 years or older with type 2 DM in the Third National Health and Nutrition Examination Survey, a probability sample of the total civilian US noninstitutionalized population conducted from 1988-1994. MAIN OUTCOME MEASURES: The GFR per 1.73 m2 BSA, calculated with serum creatinine, ureanitrogen, and serum albumin levels using the Modification of Diet in Renal Disease Study prediction equation; albuminuria, assessed using spot urine albumin/creatinine ratio; and presence of retinopathy, determined with fundus photography. RESULTS: Overall, 13% (sampled n = 171) of adults with type 2 DM (n = 1197) had CRI with a population estimate of 1.1 million. Among these adults with CRI, diabetic retinopathy was noted in 28% (n = 58), while the frequencies of microalbuminuria and macroalbuminuria were 45% (n = 64) and 19% (n = 47), respectively. Retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were both absent in 30% (n = 51) of adults with type 2 DM and CRI. The population estimate of adults with type 2 DM and CRI in the absence of diabetic retinopathy or albuminuria was approximately 0.3 million. CONCLUSIONS: A substantial burden of CRI among persons with type 2 DM in the United States is likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis. Approaches to screening renal disease in the type 2 DM population should incorporate assessment of GFR in addition to monitoring urine albumin excretion and funduscopic changes to ensure that individuals with type 2 DM and CRI not due to diabetic glomerulosclerosis will receive appropriate intervention.
Authors: Laura C Plantinga; Deidra C Crews; Josef Coresh; Edgar R Miller; Rajiv Saran; Jerry Yee; Elizabeth Hedgeman; Meda Pavkov; Mark S Eberhardt; Desmond E Williams; Neil R Powe Journal: Clin J Am Soc Nephrol Date: 2010-03-25 Impact factor: 8.237
Authors: Ankur Jindal; Mariana Garcia-Touza; Nidhi Jindal; Adam Whaley-Connell; James R Sowers Journal: Endocrinol Metab Clin North Am Date: 2013-08-01 Impact factor: 4.741
Authors: Elizabeth F O Kern; Miriam Maney; Donald R Miller; Chin-Lin Tseng; Anjali Tiwari; Mangala Rajan; David Aron; Leonard Pogach Journal: Health Serv Res Date: 2006-04 Impact factor: 3.402
Authors: Zongzhong Tong; Zhenglin Yang; Shrena Patel; Haoyu Chen; Daniel Gibbs; Xian Yang; Vincent S Hau; Yuuki Kaminoh; Jennifer Harmon; Erik Pearson; Jeanette Buehler; Yuhong Chen; Baifeng Yu; Nicholas H Tinkham; Norman A Zabriskie; Jiexi Zeng; Ling Luo; Jennifer K Sun; Manvi Prakash; Rola N Hamam; Stephen Tonna; Ryan Constantine; Cecinio C Ronquillo; SriniVas Sadda; Robert L Avery; John M Brand; Nyall London; Alfred L Anduze; George L King; Paul S Bernstein; Scott Watkins; Lynn B Jorde; Dean Y Li; Lloyd Paul Aiello; Martin R Pollak; Kang Zhang Journal: Proc Natl Acad Sci U S A Date: 2008-05-05 Impact factor: 11.205