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Determinants of decline in glomerular filtration rate in nonproteinuric subjects with or without diabetes and hypertension.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2009 Sep; Vol. 4 (9), pp. 1432-40. - Publication Year :
- 2009
-
Abstract
- Background and Objectives: This study investigated whether the slope of estimated GFR is different between nonproteinuric subjects with and without diabetes, and what clinical factors are associated with the GFR slope.<br />Design, Setting, Participants, & Measurements: An observational cohort study was performed in 923 subjects, and the predictive value of baseline variables on the GFR slope was investigated.<br />Results: On the basis of the median 3-yr follow-up and 7 measurements of GFR, GFR slope (%/yr, median and interquartile range) was significantly larger in subjects with diabetes (-2.39 (-4.86 to 0.15), n=729) than in those without diabetes (-1.02 (-4.28 to 1.37), n=194), and this difference remained significant with or without presence of hypertension. After adjustments for confounding factors, predictors of GFR decline were found to be baseline high values of glycosylated hemoglobin A1C(HbA1C), GFR, systolic blood pressure, and low plasma total protein in subjects with diabetes, whereas only the latter two were significant in subjects without diabetes. In subjects with diabetes, the high GFR was accounted for by high HbA1C at baseline, and the predictors of GFR decline differed between those with and without hypertension, or with high and low baseline GFR. Any combination of the predictors showed increased risk for GFR decline.<br />Conclusions: GFR slope is substantially affected by multiple factors at various stages. The degree of chronic hyperglycemia is likely to play a crucial role in elevating GFR and accelerating the decline in patients with type 2 diabetes even from the normoalbuminuric stage.
- Subjects :
- Aged
Biomarkers blood
Blood Glucose metabolism
Blood Pressure
Blood Proteins metabolism
Diabetes Mellitus, Type 2 blood
Diabetes Mellitus, Type 2 physiopathology
Diabetic Nephropathies blood
Diabetic Nephropathies physiopathology
Female
Glycated Hemoglobin metabolism
Humans
Hypertension blood
Hypertension physiopathology
Kidney Diseases blood
Kidney Diseases physiopathology
Linear Models
Male
Middle Aged
Models, Biological
Risk Assessment
Risk Factors
Time Factors
Diabetes Mellitus, Type 2 complications
Diabetic Nephropathies etiology
Glomerular Filtration Rate
Hypertension complications
Kidney physiopathology
Kidney Diseases etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 4
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 19713288
- Full Text :
- https://doi.org/10.2215/CJN.06511208