Abstract
Proteinuria is an important risk factor in diabetic nephropathy. Nonproteinuria subjects with type 2 diabetes often develop chronic kidney disease (CKD). To clarify the extent of renal damage in such subjects, we studied risk factors associated with renal function reduction in those with type 2 diabetes with and without microalbuminuria. Subjects numbered 638 with type 2 diabetes -513 with nonalbuminuria and 125 with microalbuminuria. Of these, 67 (13.6%) without albuminuria and 40 (32%) with microalbuminuria had Ccr lower than 60 ml/minute, indicating CKD. Multivariate stepwise linear regression analysis indicated that systolic blood pressure (p=0.00004), body mass index (BMI) (p=0.00010), diabetes duration (p=0.00054), and HbA1c (p=0.02606) were independent risk factors for urinary albumin excretion (UAE) exceeding 30 mg/gCr, while age (p<0.0001), UAE (p=0.00004), and waist circumference (p=0.00055) were independent risk factors for Ccr lower than 60 ml/minute. Risk factors for CKD between type 2 diabetes with microalbuminuria compared to those without proteinuria differed in renal function reduction. We concluded that to prevent kidney disease in diabetic patients, diabetes, hypertension, and obesity should all be managed together. Our results also indicate different etiologies for diabetic nephropathy and CKD.
