Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

Aims/hypothesis. We aimed to examine risk factors for, and differences in, renal failure in diabetic patients from 10 centres. Methods. Risk factors for renal failure were examined in 3558 diabetic pati ents who did not have renal disease at baseline in the WHO Multinational St udy of Vascular Disease in Diabetes (WHO MSVDD). Results. In 959 subjects with Type I (insulin-dependent) diabetes mellitus and 2559 with Type II (noninsulin-dependent) diabetes mellitus, the average follow-up was 8.4 years (+/-2.7). By the end of the follow-up period 53 pa tients in the Type I diabetic group and 134 patients in the Type II diabeti c group had developed renal failure (incidence rate 6.3:1000 person years). Increasing age and duration of diabetes were associated with renal failure in Type II and Type I diabetes. In Type II diabetes duration of diabetes w as a more important risk factor than age. In both Type I and Type II diabet ic retinopathy and proteinuria were strongly associated with renal failure. Systolic blood pressure was associated with renal failure in Type I but no t in Type II diabetic patients. ECG ab normalities at baseline, self-report ed smoking and cholesterol were not associated with renal failure. Triglyce rides were measured in a subset of centres. Among those with Type II, but n ot Type I diabetes, triglycerides were associated with renal failure indepe ndently of systolic blood pressure, proteinuria or retinopathy. In Type II diabetes fasting plasma glucose was associated with renal failure independe ntly of other risk factors. Conclusion/interpretation. We have confirmed the role of proteinuria and re tinopathy as markers of renal failure and the importance of hyperglycaemia in renal failure in Type I and Type If diabetes. Plasma triglycerides seem to be an important predictor of renal failure in Type II diabetes. In Type I diabetes systolic blood pressure is an important predictor of renal failu re.