부산대학교 도서관

Aim The first clinical manifestation of diabetic kidney disease is usually the development of microalbuminuria. However, recent studies have focused on diabetic patients with reduced glomerular filtration rate ( GFR) without albuminuria. To evaluate the association of albuminuria and GFR with renal outcomes, we performed an observational study. Methods A total of 3231 type 2 diabetic patients were included in this study between 2003 and 2005. There were 1249 women and the mean age was 59 ± 12 years. The renal endpoints were defined as the initiation of renal replacement therapy ( RRT) or 50% reduction from the baseline of estimated GFR (eGFR). Results At baseline, 669 (20.7%) patients had eGFR <60 mL/min per 1.73 m2 and 1134 (35.1%) had albuminuria. During the mean follow-up period of 5.9 ± 1.6 years, 107 patients initiated RRT. A 50% reduction of eGFR from the baseline value was found in 279 patients. None of the normoalbuminuric subjects with or without reduced eGFR required RRT during the observational period ( P < 0.01). Compared to normoalbuminuria patients with eGFR ≥60 mL/min per 1.73 m2 at baseline, the group of normoalbuminuria patients with reduced eGFR had a 2.5-fold risk of developing the renal endpoints, (95% confidence interval ( CI): 1.0-6.3, P = 0.053). Patients with microalbuminuria with eGFR ≥60 mL/min per 1.73 m2 at baseline had a 5.0-fold risk of developing the evaluated renal endpoints (95% CI: 2.8-8.8, P < 0.001). Conclusion Albuminuria was a significant predictor for the evaluated renal endpoints, but the impact of eGFR is likely to be less than that of albuminuria. [ABSTRACT FROM AUTHOR]