The impact of metabolic and blood pressure control on incidence and progression of nephropathy - A 10-year study of 385 type 2 diabetic patients

The aim of the present study was to find clinical parameters affecting inci dence and progression of nephropathy in type 2 diabetic patients. A prospec tive study for 10 years was performed in 385 type 2 diabetic patients (diab etes diagnosis greater than or equal to 30 years) attending a hospital-base d outpatient clinic. Medical risk indicators like diabetes duration, HbA(1c ), and blood pressure were related to the development and progression of di abetic nephropathy. The 10-year incidence of microalbuminuria was 38% (n = 95) and that of macroalbuminuria was 10% (n = 26). Out of 103 patients with microalbuminuria, 38 developed macroalbuminuria. In 252 normoalbuminuric p atients, the mean of the HbA(1c) (P < .05) levels obtained during the study were associated with a doubling of the fractional albumin clearance. In co ntrast, blood pressure levels, age, diabetes duration, type of diabetes tre atment, BMI, and gender were not (Cox regression analysis). Among 133 patie nts with micro- or macroalbuminuria, 22 more than doubled their serum creat inine level, in contrast to only 6 of 252 patients without. With Cox regres sion analysis, systolic (P < .01), but not diastolic, blood pressure or HbA (1c) levels or the abovementioned risk factors were associated with a doubl ing in serum creatinine. A total of 19 patients developed uremia during the study, out of whom 6 were in need of dialysis and I has had a renal transp lantation, and 14 (74%) died. HbA(1c) (P < .05) and systolic blood pressure (P < .001) levels were associated with development of uremia, but not dias tolic blood pressure or the other parameters mentioned above. This study sh ows that poor metabolic control is associated with development and high blo od pressure with progression of nephropathy in type 2 diabetic patients. (C ) 2001 Elsevier Science Inc. All rights reserved.