Prevalence and Clinical Characteristics of Normoalbuminuric Type 2 Diabetic Patients with Reduced Glomerular Filtration Rate

正常白蛋白尿在第二型糖尿病合併下降的腎小球過濾率之病人的盛行率與臨床特徵

陳勅因(Chih-Yin Chen) ； 蘇聖棋(Sheng-Chi Su) ； 鄭力升(Li-Sheng Cheng) ； 郭錫恭(Hsi-Kung Kuo) ； 劉瑞川(Rue-Tsuan Liu)

《Acta Nephrologica》 23卷2期 (2009/06) Pp. 96-102

並列摘要

Background: In classical diabetic glomerulopathy, developing macroalbuminuria is thought to be the requisite for loss of glomerular filtration rate (GFR). However, emerging data in the western countries showed normoalbuminuria in a substantial proportion of patients with reduced GFR.
Objective: To determine the frequency of normoalbuminuria in type 2 diabetic patients with reduced GFR, defined as a GFR ＜60 ml/min per 1.73 m2 body surface area and to analyze their clinical characteristics.
Materials and methods: A total of 1147 type 2 diabetic patients were recruited in this cross-sectional study. Among them, 952 patients had gradeable fundus examinations. The Mothfication of Diet in Renal Disease formula was used to estimate GFR. At least two measures of albumin-to-creatinine ratio or semiquantitative strip test were used to determine albuminuria (microalbuminuria or macroalbuminuria).
Results: Reduced GFR was noted in 24.2% (278/1147) of type 2 diabetic patients. The absence of albuminuria was noted in 36.7% (1021278) of type 2 diabetic patients with reduced CFR. Additionally, both absences of retinopathy and albuminuria were noted in 23.5% (54/230) of type 2 diabetic patients with reduced GFR. Among the 565 normoalbuminuric patients, 14.3% patients (81/565) had reduced GFR. In univariate analyses, we found that the patients with reduced GFR were older, had higher BMI, waist circumference, higher proportion of hypertension, and used more rennin-angiotensin system (RAS) inhibitors, and lipid-lowering agents than the group without reduced GFR. Multivariate logistic regression analysis revealed that age, waist circumference, and hypertension were independently associated with reduced GFR. After excluding the users of RAS inhibitors, only age and waist circumference were independently associated with reduced GFR.
Conclusion: A substantial proportion of type2 diabetic patients with reduced GFR manifest normoalbuminuria. Older age, increased waist circumference and hypertension contribute independently to reduced GFR in normoalbuminuria type 2 diabetic patients.

並列關鍵字

albuminuria ； gloinerular filtration rate ； prevalence ； diabetic retinopathy ； diabetic nephropathy ； type 2 diabetes mellitus