The outcome of advanced chronic nephropathy in type 1 and type 2 diabetic and non-diabetic patients: A prospective study

To compare end-stage progression of nephropathy in type 1 and type 2 diabet ic patients and non-diabetic subjects, we prospectively studied 92 patients with advanced uraemia not yet on dialysis (mean age 57.2 +/- 15.0 years), with a serum creatinine level above 200 mu mol/L. The study included monthl y serum creatinine (SC) measurements and quarterly outpatient follow-up (me an 10.8 +/- 7.1 months, range 1-21). Sixty subjects (65.2 %) were diabetic (28 type 1 and 32 type 2). At inclusion, 95.6 % of patients had anti-hypert ensive medications. Drug category, dosage and combination were similar for both groups. Blood pressure (less than or equal to 130/85 mmHg) and glucose level targets (fasting less than or equal to 7.5 mmol/L and postprandial l ess than or equal to 10 mmol/L) were obtained in all patients. Initial SC w as not significantly different between diabetic and non-diabetic patients ( 426.5 +/- 189.4 mu mol/L vs. 405.1 +/- 201.9 mu mol/L). SC increased signif icantly faster in diabetic than non-diabetic patients (respectively 3.9 =/- 6.1 % and 1.5 +/- 4.6 % monthly, p < 0.05), with no difference between typ e 1 and type 2 diabetes. One-third (33.7 %) of all patients started dialysi s during follow-up (40 % diabetic and 22 % non-diabetic). Their weight, bod y mass index, age,sex ratio. treatment and aetiology were similar. During f ollow-up, the patients (29.4 %) who sustained a major Vascular event differ ed only in age (62.1 years vs. 55.2 years; p < 0.001). In this study, diabe tic renal disease worsened significantly faster than other nephropathies, i n spite of proper normalisation of blood pressure and glucose level. Theref ore, it is essential to diagnose and manage Type 2 diabetes early to avoid encumbering dialysis centres with older patients.