Progression of diabetic nephropathy, risk of end-stage renal disease and mortality in patients with type-1 diabetes.

Numerous studies have shown that diabetic nephropathy (DNP) is associated with an elevated risk of progression toward end-stage renal disease (ESRD) as well as increased cardiovascular mortality. The majority of these studies are from the developed countries. The factors leading to the progression of DNP may not be quite the same in the developing countries. The aim of this study was to evaluate the risk factors of progression toward ESRD and mortality among type-1 diabetes (T1D) patients with DNP in a developing country. This prospective study was conducted enrolling 72 patients with T1D in September 2006, including T1D patients with DNP defined as microalbuminuria, proteinuria, and/or renal failure, and following them up for five years. The mean age was 29.5±7.5 years with a mean duration of diabetes of 17 (11-20) years. At the time of enrollment, 43.1% had arterial hypertension, 69.4% had proliferative retinopathy, 44.4 had clinical neuropathy, 25% lived in rural areas, and 51.4% had macroalbuminuria. Progression toward ESRD was observed in 34.7% of cases. In multivariate analysis, diastolic blood pressure (P = 0.006) and blood hemoglobin (P = 0.003) were identified as the risk factors associated with ESRD. Death occurred in 18.3% of cases, including 92.3% on hemodialysis with a median hemodialysis duration of six (1-60) months. In multivariate analysis, the ESRD was identified as risk factor for death (P <0.001). DNP due to T1D remains a disease involving a heavy burden of morbi-mortality and is difficult to manage in a developing country because of the low socioeconomic level of patients and the lack of reliable epidemiological data.