Risk factors for diabetic kidney disease identified

High blood pressure and high lipid levels, as well as longer disease duration, elevated glucose (sugar) levels, and male gender, are all significant risk factors for kidney disease in patients with type 1 diabetes, according to a report in the current issue of Diabetes Care.

"Diabetes care must continue to focus on improvement of metabolic control, but also on monitoring...lipids and blood pressure." High blood pressure and high blood lipid levels should be treated as soon as they are diagnosed, lead author Dr. Klemens Raile, from Charite Children's Hospital in Berlin, told Reuters Health. Our study is in agreement with other studies that show lower levels of kidney disease in patients who have good control over their blood glucose levels.

The researchers analyzed data from 27,805 patients included in the nationwide, prospective German Diabetes Documentation System survey. The average ages at diagnosis and at last visit were 10 and 16 years old, respectively, while the average follow-up time was 2.5 years.

Overall, 26,605 subjects had normal urine test results, 919 had low levels of protein in the urine, 78 had high levels of protein in the urine, and 203 had end-stage renal (kidney) disease (ESRD), the report indicates.

With further analysis, they found that for patients who had diabetes for 40 years 25.4 percent had low levels of urine protein and 9.4 percent had ESRD.

Predictors of low urine protein levels included longer diabetes duration, elevated glucose, elevated LDL cholesterol - the "bad" cholesterol - and high blood pressure, the researchers found. By contrast, young age at diabetes onset was tied to a reduced risk of low protein urine levels, which is consistent with findings from earlier studies.

Male gender was identified as risk factor for high protein levels in the urine, the report indicates.

"We are very pleased that the rate of (kidney) disease and (particularly) ESRD is relatively low," Raile said.

However, it is "alarming" that high blood lipid levels and high blood pressure are often not treated adequately.

The team concludes that prompt diagnosis and treatment of abnormal lipid levels and high blood pressure is "mandatory in patients with type 1 diabetes."

SOURCE: Diabetes Care, October 2007.