FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 335:1636-1642 November 28, 1996 Number 22 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly defined.

Methods We studied glomerular function at intervals of 6 to 12 months for 4 years in 194 Pima Indians selected to represent different stages in the development and progression of diabetic renal disease. Initially, 31 subjects had normal glucose tolerance, 29 had impaired glucose tolerance, 30 had newly diagnosed diabetes, and 104 had had diabetes for five years or more; of these 104, 20 had normal albumin excretion, 50 had microalbuminuria, and 34 had macroalbuminuria. The glomerular filtration rate, renal plasma flow, urinary albumin excretion, and blood pressure were measured at each examination.

Results Initially, the mean (±SE) glomerular filtration rate was 143±7 ml per minute in subjects with newly diagnosed diabetes, 155±7 ml per minute in those with microalbuminuria, and 124±7 ml per minute in those with macroalbuminuria; these values were 16 percent, 26 percent, and 1 percent higher, respectively, than in the subjects with normal glucose tolerance (123±4 ml per minute). During four years of follow-up, the glomerular filtration rate increased by 18 percent in the subjects who initially had newly diagnosed diabetes (P = 0.008); the rate declined by 3 percent in those with microalbuminuria at base line (P = 0.29) and by 35 percent in those with macroalbuminuria (P<0.001). Higher base-line blood pressure predicted increasing urinary albumin excretion (P = 0.006), and higher base-line urinary albumin excretion predicted a decline in the glomerular filtration rate (P<0.001). The initial glomerular filtration rate did not predict worsening albuminuria.

Conclusions The glomerular filtration rate is elevated at the onset of NIDDM and remains so while normal albumin excretion or microalbuminuria persists. It declines progressively after the development of macroalbuminuria.

Source Information

From the Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Ariz. (R.G.N., P.H.B., W.C.K.); the Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland (G.J.B., M.T.); the Renal Division, Emory University School of Medicine, Atlanta (W.E.M.); the Chronic Renal Disease Program, Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md. (G.H.H.); and the Division of Nephrology, Stanford University School of Medicine, Stanford, Calif. (B.D.M.).

Address reprint requests to Dr. Beck at the Diabetic Renal Disease Study Data Coordinating Center, Department of Biostatistics and Epidemiology, Desk P88, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.

Full Text of this Article

This article has been cited by other articles:

• Fox, C. S., Muntner, P. (2008). Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988-1994 to 1999-2004. Diabetes Care 31: 1337-1342 [Abstract] [Full Text]  
• Stevens, L. A., Coresh, J., Feldman, H. I., Greene, T., Lash, J. P., Nelson, R. G., Rahman, M., Deysher, A. E., Zhang, Y., Schmid, C. H., Levey, A. S. (2007). Evaluation of the Modification of Diet in Renal Disease Study Equation in a Large Diverse Population. J. Am. Soc. Nephrol. 18: 2749-2757 [Abstract] [Full Text]  
• Scavini, M., Stidley, C. A., Paine, S. S., Shah, V. O., Tentori, F., Bobelu, A., Welty, T. K., MacCluer, J. W., Zager, P. G. (2007). The Burden of Chronic Kidney Disease among the Zuni Indians: The Zuni Kidney Project. CJASN 2: 509-516 [Abstract] [Full Text]  
• Otu, H. H., Can, H., Spentzos, D., Nelson, R. G., Hanson, R. L., Looker, H. C., Knowler, W. C., Monroy, M., Libermann, T. A., Karumanchi, S. A., Thadhani, R. (2007). Prediction of Diabetic Nephropathy Using Urine Proteomic Profiling 10 Years Prior to Development of Nephropathy. Diabetes Care 30: 638-643 [Abstract] [Full Text]  
• Athyros, V. G., Mikhailidis, D. P., Liberopoulos, E. N., Kakafika, A. I., Karagiannis, A., Papageorgiou, A. A., Tziomalos, K., Ganotakis, E. S., Elisaf, M. (2007). Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: A subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. Nephrol Dial Transplant 22: 118-127 [Abstract] [Full Text]  
• de Jong, P. E., Curhan, G. C. (2006). Screening, Monitoring, and Treatment of Albuminuria: Public Health Perspectives. J. Am. Soc. Nephrol. 17: 2120-2126 [Abstract] [Full Text]  
• Musso, C., Javor, E., Cochran, E., Balow, J. E, Gorden, P. (2006). Spectrum of Renal Diseases Associated with Extreme Forms of Insulin Resistance. CJASN 1: 616-622 [Abstract] [Full Text]  
• Rietveld, I, Hofman, A, Pols, H A P, van Duijn, C M, Lamberts, S W J, Janssen, J A M J L (2006). An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance.. Eur J Endocrinol 154: 715-721 [Abstract] [Full Text]  
• Xu, J., Lee, E. T, Best, L. G, Begum, M., Knowler, W. C, Fabsitz, R. R, Howard, B. V (2005). Association of albuminuria with all-cause and cardiovascular disease mortality in diabetes: the Strong Heart Study. British Journal of Diabetes & Vascular Disease 5: 334-340 [Abstract]  
• Jee, S. H., Boulware, L. E., Guallar, E., Suh, I., Appel, L. J., Miller, E. R. III (2005). Direct, Progressive Association of Cardiovascular Risk Factors With Incident Proteinuria: Results From the Korea Medical Insurance Corporation (KMIC) Study. Arch Intern Med 165: 2299-2304 [Abstract] [Full Text]  
• Fox, C. S., Larson, M. G., Leip, E. P., Meigs, J. B., Wilson, P. W.F., Levy, D. (2005). Glycemic Status and Development of Kidney Disease: The Framingham Heart Study. Diabetes Care 28: 2436-2440 [Abstract] [Full Text]  
• Lemley, K. V., Boothroyd, D. B., Blouch, K. L., Nelson, R. G., Jones, L. I., Olshen, R. A., Myers, B. D. (2005). Modeling GFR trajectories in diabetic nephropathy. Am. J. Physiol. Renal Physiol. 289: F863-F870 [Abstract] [Full Text]  
• Mathew, R., Futterweit, S., Valderrama, E., Tarectecan, A. A., Bylander, J. E., Bond, J. S., Trachtman, H. (2005). Meprin-{alpha} in chronic diabetic nephropathy: interaction with the renin-angiotensin axis. Am. J. Physiol. Renal Physiol. 289: F911-F921 [Abstract] [Full Text]  
• Perkins, B. A., Nelson, R. G., Ostrander, B. E.P., Blouch, K. L., Krolewski, A. S., Myers, B. D., Warram, J. H. (2005). Detection of Renal Function Decline in Patients with Diabetes and Normal or Elevated GFR by Serial Measurements of Serum Cystatin C Concentration: Results of a 4-Year Follow-Up Study. J. Am. Soc. Nephrol. 16: 1404-1412 [Abstract] [Full Text]  
• Stuveling, E. M., Bakker, S. J. L., Hillege, H. L., de Jong, P. E., Gans, R. O. B., de Zeeuw, D. (2005). Biochemical risk markers: a novel area for better prediction of renal risk?. Nephrol Dial Transplant 20: 497-508 [Full Text]  
• Gaede, P., Tarnow, L., Vedel, P., Parving, H.-H., Pedersen, O. (2004). Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant 19: 2784-2788 [Abstract] [Full Text]  
• Zhao, H.-L., Tong, P. C.Y., Lai, F. M.M., Tomlinson, B., Chan, J. C.N. (2004). Association of Glomerulopathy With the 5'-End Polymorphism of the Aldose Reductase Gene and Renal Insufficiency in Type 2 Diabetic Patients. Diabetes 53: 2984-2991 [Abstract] [Full Text]  
• Looker, H. C., Krakoff, J., Funahashi, T., Matsuzawa, Y., Tanaka, S., Nelson, R. G., Knowler, W. C., Lindsay, R. S., Hanson, R. L. (2004). Adiponectin Concentrations Are Influenced by Renal Function and Diabetes Duration in Pima Indians with Type 2 Diabetes. J. Clin. Endocrinol. Metab. 89: 4010-4017 [Abstract] [Full Text]  
• Smith, D. H., Gullion, C. M., Nichols, G., Keith, D. S., Brown, J. B. (2004). Cost of Medical Care for Chronic Kidney Disease and Comorbidity among Enrollees in a Large HMO Population. J. Am. Soc. Nephrol. 15: 1300-1306 [Abstract] [Full Text]  
• Young, B. A., Pugh, J. A., Maynard, C., Reiber, G. (2004). Diabetes and Renal Disease in Veterans. Diabetes Care 27: B45-B49 [Abstract] [Full Text]  
• Chen, J., Muntner, P., Hamm, L. L., Jones, D. W., Batuman, V., Fonseca, V., Whelton, P. K., He, J. (2004). The Metabolic Syndrome and Chronic Kidney Disease in U.S. Adults. ANN INTERN MED 140: 167-174 [Abstract] [Full Text]  
• Boulware, L. E., Jaar, B. G., Tarver-Carr, M. E., Brancati, F. L., Powe, N. R. (2003). Screening for Proteinuria in US Adults: A Cost-effectiveness Analysis. JAMA 290: 3101-3114 [Abstract] [Full Text]  
• Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L. Jr, Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T. Jr, Roccella, E. J., the National High Blood Pressure Education Program, (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42: 1206-1252 [Abstract] [Full Text]  
• Bruno, G., Merletti, F., Biggeri, A., Bargero, G., Ferrero, S., Pagano, G., Perin, P. C. (2003). Progression to Overt Nephropathy in Type 2 Diabetes: The Casale Monferrato Study. Diabetes Care 26: 2150-2155 [Abstract] [Full Text]  
• Hovind, P., Rossing, P., Tarnow, L., Parving, H.-H. (2003). Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes. Diabetes Care 26: 911-916 [Abstract] [Full Text]  
• Chen, J., Muntner, P., Hamm, L. L., Fonseca, V., Batuman, V., Whelton, P. K., He, J. (2003). Insulin Resistance and Risk of Chronic Kidney Disease in Nondiabetic US Adults. J. Am. Soc. Nephrol. 14: 469-477 [Abstract] [Full Text]  
• Krakoff, J., Lindsay, R. S., Looker, H. C., Nelson, R. G., Hanson, R. L., Knowler, W. C. (2003). Incidence of Retinopathy and Nephropathy in Youth-Onset Compared With Adult-Onset Type 2 Diabetes. Diabetes Care 26: 76-81 [Abstract] [Full Text]  
• Meigs, J. B., D'Agostino, R. B. Sr., Nathan, D. M., Rifai, N., Wilson, P. W.F. (2002). Longitudinal Association of Glycemia and Microalbuminuria: The Framingham Offspring Study. Diabetes Care 25: 977-983 [Abstract] [Full Text]  
• Bonow, R. O., Mitch, W. E., Nesto, R. W., O'Gara, P. T., Becker, R. C., Clark, L. T., Hunt, S., Jialal, I., Lipshultz, S. E., Loh, E. (2002). Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: Management of Cardiovascular-Renal Complications. Circulation 105 : e159-e164 [Full Text]  
• Parving, H.-H., Chaturvedi, N., Viberti, G., Mogensen, C. E. (2002). Does Microalbuminuria Predict Diabetic Nephropathy?. Diabetes Care 25: 406-407 [Full Text]  
• Arauz-Pacheco, C., Parrott, M. A., Raskin, P. (2002). The Treatment of Hypertension in Adult Patients With Diabetes. Diabetes Care 25: 134-147 [Full Text]  
• Christensen, P. K., Larsen, S., Horn, T., Olsen, S., Parving, H.-H. (2001). Renal function and structure in albuminuric type 2 diabetic patients without retinopathy. Nephrol Dial Transplant 16: 2337-2347 [Abstract] [Full Text]  
• Parving, H.-H., Lehnert, H., Brochner-Mortensen, J., Gomis, R., Andersen, S., Arner, P., the Irbesartan in Patients with Type 2 Diabetes an, (2001). The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. NEJM 345: 870-878 [Abstract] [Full Text]  
• Meigs, J. B., Jacques, P. F., Selhub, J., Singer, D. E., Nathan, D. M., Rifai, N., D'Agostino, R. B. Sr., Wilson, P. W.F. (2001). Fasting Plasma Homocysteine Levels in the Insulin Resistance Syndrome: The Framingham Offspring Study. Diabetes Care 24: 1403-1410 [Abstract] [Full Text]  
• LEMLEY, K. V., BLOUCH, K., ABDULLAH, I., BOOTHROYD, D. B., BENNETT, P. H., MYERS, B. D., NELSON, R. G. (2000). Glomerular Permselectivity at the Onset of Nephropathy in Type 2 Diabetes Mellitus. J. Am. Soc. Nephrol. 11: 2095-2105 [Abstract] [Full Text]  
• PRICE, D. A., PORTER, L. E., GORDON, M., FISHER, N. D. L., DE'OLIVEIRA, J. M. F., LAFFEL, L. M. B., PASSAN, D. R., WILLIAMS, G. H., HOLLENBERG, N. K. (1999). The Paradox of the Low-Renin State in Diabetic Nephropathy. J. Am. Soc. Nephrol. 10: 2382-2391 [Abstract] [Full Text]  
• UK Prospective Diabetes Study Group, (1998). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703-713 [Abstract] [Full Text]  
• Parving, H.-H. (1996). Initiation and Progression of Diabetic Nephropathy. NEJM 335: 1682-1683 [Full Text]