Skip to main content
SpringerLink
Log in

Effect of metabolic factors and blood pressure on kidney function in proteinuric Type 2 (non-insulin-dependent) diabetic patients

  • Published:
Diabetologia Aims and scope Submit manuscript

Summary

Decline of kidney function with time and its influencing factors were investigated in the present longitudinal study in Type 2 (non-insulin-dependent) diabetic patients with clinical diabetic nephropathy. Compared to a control group of Type 2 diabetic patients without proteinuria, the proteinuric patients showed a higher prevalence of hypertension, higher systolic blood pressure values and serum triglyceride levels. The annual loss of glomerular kidney function was much higher in the proteinuric patients (5.3 ml·min−1·1.73 m2) than in the control subjects (0.9 ml·min−1·1.73 m2). Correlation analyses revealed a close correlation between the annual decrease of kidney function and the factors, systolic and diastolic blood pressure, triglyceride and postprandial blood glucose level as well as body mass index. Regression analyses showed for the first time that in addition to the systolic blood pressure and metabolic control, the triglyceride level is also an independent factor influencing the progression of nephropathy. Higher values of these parameters were associated with a more rapid deterioration of kidney function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brunner FP, Selwood NH (1992) Profile of patients on RRT in Europe and death rates due to major causes of death groups. Kidney Int 42 [Suppl 38]: S4-S15

    Google Scholar 

  2. Humphrey LL, Ballard DJ, Frohnert PP, Chu C-P, O'Fallon M, Palumbo PJ (1989) Chronic renal failure in non-insulin-dependent diabetes mellitus. Ann Int Med 111: 788–796

    CAS  PubMed  Google Scholar 

  3. Kunzelman CL, Knowler WC, Pettitt DJ, Bennett PH (1989) Incidence of proteinuria in type 2 diabetes mellitus in the Pima Indians. Kidney Int 35: 681–687

    CAS  PubMed  Google Scholar 

  4. Hasslacher C, Ritz E, Wahl P, Michael C (1989) Similar risks of nephropathy in patients with type 1 or type 2 diabetes. Nephrol Dial Transplant 4: 859–863

    CAS  PubMed  Google Scholar 

  5. Ritz E, Nowack R, Fliser D, Koch M, Tschöpe W (1991) Type II diabetes mellitus: is the renal risk adequately appreciated? Nephrol Dial Transplant 6: 679–682

    CAS  PubMed  Google Scholar 

  6. Ordonez JD, Hiatt RA (1989) Comparison of type 2 and type 1 diabetics treated for end-stage renal disease in a large prepaid health plan population. Nephron 51: 524–529

    CAS  PubMed  Google Scholar 

  7. Fabre J, Balant LP, Dayer PG, Fox HM, Vernet AT (1982) The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 21: 730–738

    CAS  PubMed  Google Scholar 

  8. Jerums G, Cooper ME, Seeman E, Murray RML, McNeil JJ (1987) Spectrum of proteinuria in type 1 and type 2 diabetes. Diabetes Care 10: 419–427

    CAS  PubMed  Google Scholar 

  9. Walker WG, Hermann J, Murphy RP, Russell RP (1990) Prospective study of the impact of hypertension upon kidney function in diabetes mellitus. Nephron 55 [Suppl 1]: 21–26

    PubMed  Google Scholar 

  10. Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. New Engl J Med 310: 356–360

    CAS  PubMed  Google Scholar 

  11. Hother-Nielsen O, Faber O, Schwartz-Sorensen N, Beck-Nielsen H (1988) Classification of newly diagnosed diabetic patients as insulin-requiring or non-insulin-requiring based on clinical and biochemical variables. Diabetes Care 11: 531–537

    CAS  PubMed  Google Scholar 

  12. Parving H-H, Gall M-A, Skott P et al. (1992) Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients. Kidney Int 41: 758–762

    CAS  PubMed  Google Scholar 

  13. Cockroft DW, Gault HM (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41

    Google Scholar 

  14. SAS users guide: statistics version 5 edn (1985) SAS Institute, Cary, NC

  15. Sampson MJ, Drury PL (1992) Accurate estimation of glomerular filtration rate in diabetic nephropathy from age, body weight, and serum creatinine. Diabetes Care 15: 609–612

    CAS  PubMed  Google Scholar 

  16. Lindeman RD, Tobin JD, Shock NW (1984) Association between blood pressure and the rate of decline in renal function with age. Kidney Int 26: 861–868

    CAS  PubMed  Google Scholar 

  17. Parving H-H, Andersen A, Smidt UM, Hommel E, Mathiesen E, Svendsen PA (1987) Effect of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 294: 1443

    CAS  PubMed  Google Scholar 

  18. Björck S, Nyberg Y, Mulec H, Granerus G, Herlitz H, Aurell M (1986) Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy. BMJ 293: 471

    PubMed  Google Scholar 

  19. Ferder L, Daccordi H, Martello M, Panzalis M, Inserra F (1992) Angiotensin converting enzyme inhibitors versus calcium antagonists in the treatment of diabetic hypertensive patients. Hypertension 19 [Suppl II]: II-237–II-242

    CAS  Google Scholar 

  20. Walker J, Viberti GC, Osterby R (1991) Glomerular structure in normo- and micro-albuminuric diabetic patients. Diabetologia 34 [Suppl 2]: A 44 (Abstract)

    Google Scholar 

  21. Bakris GL, Barnhill BW, Sadler R (1992) Treatment of arterial hypertension in diabetic humans: importance of therapeutic selection. Kidney Int 41: 912–919

    CAS  PubMed  Google Scholar 

  22. Niskanen L, Uusitupa M, Sarlund H et al. (1990) Microalbuminuria predicts the development of serum lipoprotein abnormalities favouring atherogenesis in newly diagnosed type 2 (non-insulin-dependent) diabetic patients. Diabetologia 33: 237–243

    Article  CAS  PubMed  Google Scholar 

  23. Seghieri G, Alviggi L, Caselli P et al. (1990) Serum lipids and lipoproteins in type 2 diabetic patients with persistent microalbuminuria. Diabetic Med 7: 810–814

    CAS  PubMed  Google Scholar 

  24. Attman P-O, Nyberg G, William-Olsson T, Knight-Gibson C, Alaupovic P (1992) Dyslipoproteinemia in diabetic renal failure. Kidney Int 42: 1381–1389

    CAS  PubMed  Google Scholar 

  25. Mulec H, Johnson S-AA, Björck S (1990) Relation between serum cholesterol and diabetic nephropathy. Lancet 335: 1537–1538

    Article  CAS  PubMed  Google Scholar 

  26. Wassermann J, Santiago A, Holthofer H, Epstein M, Schlondorff D (1989) Interactions of low density lipoprotein with rat mesangial cells. Kidney Int 35: 1168–1174

    Google Scholar 

  27. Gröne H-J, Walli AK, Gröne E, Krämer A, Clemens MR, Seidel D (1990) Receptor mediated uptake of apo B and apo E rich lipoproteins by human glomerular epithelial cells. Kidney Int 37: 1449–1459

    PubMed  Google Scholar 

  28. Rayner HC, Ross-Gilbertson VL, Walls J (1990) The role of lipids in the pathogenesis of glomerulosclerosis in the rat following subtotal nephrectomy. Eur J Clin Invest 20: 97–104

    CAS  PubMed  Google Scholar 

  29. Kasiske BL, O'Donnell MP, Schmitz PG (1990) Renal injury of diet-induced hypercholesterolemia in rats. Kidney Int 37: 880–891

    CAS  PubMed  Google Scholar 

  30. Rabelink AJ, Hene RJ, Erkelens DW, Joles JA, Koomans HA (1990) Partial remission of nephrotic syndrome in patients on long-term simvastatin. Lancet 335: 1045–1046

    Article  CAS  PubMed  Google Scholar 

  31. Hommel E, Andersen P, Gall M-A et al. (1992) Plasma lipoproteins and renal function during simvastatin treatment in diabetic nephropathy. Diabetologia 35: 447–451

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Medical University Clinic, Bergheimer Str. 38, D-69115, Heidelberg, Germany

    C. Hasslacher, A. Bostedt-Kiesel, H. P. Kempe & P. Wahl

Authors
  1. C. Hasslacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bostedt-Kiesel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. P. Kempe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Wahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hasslacher, C., Bostedt-Kiesel, A., Kempe, H.P. et al. Effect of metabolic factors and blood pressure on kidney function in proteinuric Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 36, 1051–1056 (1993). https://doi.org/10.1007/BF02374498

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02374498

Key words

Search

Navigation