SIMILAR RATE OF PROGRESSION IN THE PREDIALYSIS PHASE IN TYPE-I AND TYPE-II DIABETES-MELLITUS

Progression of diabetic nephropathy from the stage of macroproteinuria with near-normal renal function until start of dialysis was compared in 16 patients with type I and 16 patients with type II diabetes melli tus. The mean creatinine clearance at the beginning of the study was 8 9 +/- 13 ml/min/1.73 m2 in patients with type I and 81 +/- 6 ml/min/1. 73 m2 in those with type II diabetes. Dialysis was started after a mea n interval of 77(44-133) months, when creatinine clearance had decreas ed to 8 +/- 2 ml/min/1.73 m2 in type I diabetic patients. The respecti ve figures for type II diabetic patients were 81(40-124) months and 7 +/- 2 ml/min/1.73 m2. The mean rate of decrease in creatinine clearanc e was 1.05 +/- 0.45 ml/min/month in type I and 0.91 +/- 0.41 ml/min/mo nth in type II diabetes. The mean rate of decrease was 1.46 +/- 0.30 m l/min/month in type I diabetic patients with a systolic BP > 160 mmHg versus 0.80 +/- 0.42 ml/min/month with < 160 mmHg (P < 0.01). In the t ype II diabetics the respective figures were 1.38 +/- 0.40 ml/min/mont h versus 0.78 +/- 0.15 ml/min/month (P < 0.01). During the observation period the prevalence of coronary heart disease increased from 6 to 5 0% in type I and from 31 to 87% in type II diabetes. In conclusion, th e rate of progression of diabetic nephropathy during the predialytic p hase is similar in type I and type II diabetes; BP adversely affects t he rate of progression to the same extent in both groups.