Renal Insufficiency in the Absence of Albuminuria and Retinopathy Among Adults With Type 2 Diabetes Mellitus

• Published in: JAMA : the journal of the American Medical Association 2003-06, Vol.289 (24), p.3273-3277
• Main Authors: Kramer, Holly J, Nguyen, Quan Dong, Curhan, Gary, Hsu, Chi-yuan
• Format: Article
• Language: English
• Subjects: Adult; Albuminuria - epidemiology; Associated diseases and complications; Biological and medical sciences; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - epidemiology; Diabetic Retinopathy - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Glomerular Filtration Rate; Humans; Male; Medical sciences; Middle Aged; Nutrition Surveys; Prevalence; Renal Insufficiency - epidemiology; Renal Insufficiency - etiology; United States - epidemiology
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.289.24.3273

CONTEXT Kidney disease in type 2 diabetes mellitus (DM) is more heterogeneous than in type 1 DM. Reduced glomerular filtration rate (GFR) among individuals with type 2 DM may not always be due to classic diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy. OBJECTIVE To determine the prevalence of chronic renal insufficiency (CRI), defined as a GFR less than 60 mL/min per 1.73 m body surface area (BSA) in the absence of microalbuminuria or macroalbuminuria and diabetic retinopathy among adults with type 2 DM. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of adults aged 40 years or older with type 2 DM in the Third National Health and Nutrition Examination Survey, a probability sample of the total civilian US noninstitutionalized population conducted from 1988-1994. MAIN OUTCOME MEASURES The GFR per 1.73 m BSA, calculated with serum creatinine, urea nitrogen, and serum albumin levels using the Modification of Diet in Renal Disease Study prediction equation; albuminuria, assessed using spot urine albumin/creatinine ratio; and presence of retinopathy, determined with fundus photography. RESULTS Overall, 13% (sampled n = 171) of adults with type 2 DM (n = 1197) had CRI with a population estimate of 1.1 million. Among these adults with CRI, diabetic retinopathy was noted in 28% (n = 58), while the frequencies of microalbuminuria and macroalbuminuria were 45% (n = 64) and 19% (n = 47), respectively. Retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were both absent in 30% (n = 51) of adults with type 2 DM and CRI. The population estimate of adults with type 2 DM and CRI in the absence of diabetic retinopathy or albuminuria was approximately 0.3 million. CONCLUSIONS A substantial burden of CRI among persons with type 2 DM in the United States is likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis. Approaches to screening renal disease in the type 2 DM population should incorporate assessment of GFR in addition to monitoring urine albumin excretion and funduscopic changes to ensure that individuals with type 2 DM and CRI not due to diabetic glomerulosclerosis will receive appropriate intervention.