FACTORS ASSOCIATED WITH THE DEVELOPMENT OF RENAL COMPLICATIONS OF DIABETES-MELLITUS IN SAO-PAULO CITY

The incidence of diabetic end-stage renal failure (ESRF) varies worldw ide and risk factors have been demonstrated in several populations. Th e objective of the present study was to identify possible factors asso ciated with the risk of development of ESRF in patients with diabetes mellitus (DM). Two groups of diabetic subjects were included in a case -control study: 1) one group was submitted to renal replacement therap ies, attending dialysis centers in Sao Paulo city and 2) the same numb er of controls without clinical nephropathy (two negative dipstick tes ts for urine protein), matched for duration of DM, were obtained from an outpatient clinic. A standardized questionnaire was used by a singl e investigator and additional data were obtained from the medical reco rds of the patients. A total of 290 diabetic patients from 33 dialysis centers were identified, and 266 questionnaires were considered to co ntain reliable information. Male/female ratios were 1.13 for ESRF and 0.49 for the control group. A higher frequency of men was observed in the ESRF group when compared with controls (53 vs 33%, P<0.00001), alt hough logistic regression analysis did not confirm an association of g ender and diabetic nephropathy (DN). Similar proportions of non-white individuals were found for both groups. Patients with insulin-dependen t diabetes mellitus (IDDM) were less common than patients with non-ins ulin-dependent diabetes mellitus (NIDDM), particularly in the control group (3.4 vs 26.3%, P<0.00001, for controls and ESRF patients, respec tively); this type of DM was associated with a higher risk of ESRF tha n NIDDM, as determined by univariate analysis or logistic regression ( OR = 4.1). Hypertension by the time of the DM diagnosis conferred a 1. 4-fold higher risk of ESRF (P = 0.04), but no difference was observed concerning the presence of a family history. Association between smoki ng and alcohol habits and increased risk was observed (OR = 4.5 and 5. 9, respectively, P<0.001). A 2.4-fold higher risk of ESRF was demonstr ated in patients with multiple hospitalizations due to DM decompensati on, which suggested poor metabolic control. Photocoagulation and neuro pathy were found to be strongly associated with ESRF but not with macr ovascular disease. Data collected in our country reinforce the higher risk attributable to IDDM and the association between hypertension and the progression of DN. Indirect evidence for an association with meta bolic control is also suggested.