Risks of rapid decline renal function in patients with type 2 diabetes

Table 1 Prevalence of albuminuria and impaired glomerular filtration rate in diabetic patients

Ref.	Population (Nationality)	Albuminuria prevalence	Impaired GFR prevalence
Parving et al[13]	International DEMAND study of 33 countries 2006 32208 type 2 diabetic patients	Microalbuminuria: 39% Macroalbuminuria: 10%	22%
Bos et al[108] data from: Herman et al[109] Hamed et al[111]	Northern Africa Systematic review of PubMed 1990-2012 > 18 years old diabetic patients	Egypt 1998: Albuminuria: 21%[109] Sudan 2008 (insulin treated diabetic patients): Albuminuria: 22%[110]	Egypt 1998-Outpatient clinics: 6.7%[109] Egypt 1995-Hospital inpatients: 46.3%[111]
Icks A and Koch M Epidemiology of chronic kidney disease in diseases. In: Wolf G. Diabetes and Kidney Disease[11], data from: Chadban et al[112]	Australia AusDiab study: a national population-based cross-sectional survey > 25 years old diabetic patients	8.70% proteinuria-spot urine protein to creatinine ratio (abnormal: > 0.20 mg/mg)	27.60%
Unnikrishnan et al[113]	Southern India CURES 45 study 17, 16 type 2 diabetic patients	Microalbuminuria: 36.9% Macroalbuminuria: 2.2%	-
Icks A and Koch M Epidemiology of chronic kidney disease in diseases. In: Wolf G. Diabetes and Kidney Disease[11], data from: Lin et al[114]	Taiwan Community-based screening 1999–2001 > 30 years old type 2 diabetic patients	29.40% proteinuria-spot urine protein to creatinine ratio (abnormal: > 0.20 mg/mg)	15.10%
Yang et al[115]	China A nationally representative sample from 14 provinces and municipalities > 20 years old diabetic patients	17.30%	19.10%
Lou Arnal et al[116]	Spain A survey of 16 Health Centers of the Alcañiz Health Sector 2008 > 18 years old, 3466 type 2 diabetic patients	31.70%	25.20%
Detournay et al[117]	France ENTRED data 2007 A survey of the national public prescription claims database Type 2 diabetic patients	-	22%
Collins et al[14]	United Status NHANES study 2005-2010 Adult diabetic patients	29.90%	19.30%
Al-Rubeaan et al[54]	Saudi Arabia SNDR data > 25 yr, 54670 type 2 diabetic patients	Microalbuminuria: 1.2% Macroalbuminuria: 8.1%	GFR < 30 mL/min per 1.73 m2: 1.50%

Albuminuria: Albumin-to-creatinine ratio (UACR) > 30 mg/g; Microalbuminuria: UACR 30-300 mg/g; Macroalbuminuria: UACR > 300 mg/g; Impaired glomerular filtration rate (GFR): Estimated GFR < 60 mL/min per 1.73 m²; DEMAND: Developing Education on Microalbuminuria for Awareness of renal and cardiovascular risk in Diabetes study; AusDiab: The Australian Diabetes, Obesity and Lifestyle Study; CURES: Chennai Urban Rural Epidemiology Study; ENTRED: Échantillon national témoin représentatif des personnes diabétiques (National Representative Sample of Diabetic Patients); NHANES: National Health and Nutrition Examination Survey; SNDR: Saudi National Diabetes Registry.

Table 2 Decline of estimated glomerular filtration rate in different populations

Population	eGFR decline (mL/min per 1.73 m2 per year)	Ref.
Healthy
PREVEND study 6894 subjects	0.55	Halbesma et al[5]
	Estimated using MDRD formula
Annual health exam, Japan	0.36	Imai et al[19]
120727 subjects	Estimated using MDRD formula modified by a Japanese coefficient
ARIC study	0.47	Matsushita et al[20]
13029 subjects	Estimated using MDRD formula
Tromso Study, Norway	1.21 (men)	Kronborg et al[21]
2249 men and 2192 women	1.19 (women) Estimated using MDRD formula
Aged without diabetes
2475 men > 65 years old	1.4	Hemmelgarn et al[22]
3163 women > 65 years old	0.8	Hemmelgarn et al[22]
Aged with diabetes
490 men > 65 years old	2.7	Hemmelgarn et al[22]
445 women > 65 years old	2.1	Hemmelgarn et al[22]
CKD
MDRD study group	3.7	MDRD study group
eGFR 25-80 mL/min per 1.73 m2, n = 28		Levey et al[23]
eGFR 7.5-24 mL/min per 1.73 m2, n = 63	4.3
African Americans with hypertension eGFR 20-65 mL/min per 1.73 m2 low mean arterial pressure, n = 380	2.21	Wright et al[24]
normal mean arterial pressure, n = 374	1.95
Tromso Study, Norway	1.03	Eriksen et al[25]
eGFR 30-59 mL/min per 1.73 m2 3047 subjects
eGFR < 60 mL/min per 1.73 m2 4231 subjects	2.65	Levin et al[26]

Data from Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group[18]; eGFR: Estimated glomerular filtration rate; CKD: Chronic kidney disease; PREVEND: Prevention of Renal and Vascular End-Stage Disease; ARIC: Atherosclerosis Risk in Communities; MDRD: Modification of Diet in Renal Disease Study.

Table 3 Definitions of rapid renal function decline

	Population (Nationality)	Rapid renal function decline	Ref.
Study
	United States 4380 patients from the community-based CHS ≥ 65 years old Follow-up: 7 yr 14% with diabetes	> 3 mL/min per 1.73 m2 per year	Reviewed by KDIGO CKD Work Group[18]: Shlipak et al[28] Rifkin et al[30]
	Taiwan 577 type 2 diabetes patients from an outpatient department in a hospital-based study 63 years old (mean age) Follow-up: 1 yr	> 3 mL/min per 1.73 m2 per year	Sheen et al[72]
	472 CKD 4-5 patients from an outpatient department in a hospital-based study 65 years old (mean age) 35.4% with diabetes Follow-up: 1.5 yr (17.3 mo)		Tsai et al[118]
	Canada 4231 patients with eGFR < 30 mL/min per 1.73 m2 from a cohort derived from all patients registered in a provincial database Follow-up: 2.5 yr (31 mo)	> 4 mL/min per 1.73 m2 per year	Levin et al[26]
	Italy 1682 type 2 diabetes patients with eGFR ≥ 60 mL/min per 1.73 m2 from an outpatient department in a hospital based study Follow-up: 10 yr	> 4% per year	Zoppini et al[70]
	Canada 3154 patients with eGFR ≥ 60 mL/min per 1.73 m2, from the community based Walkerton Health Study (2002 to 2008) Follow-up: 7 yr	> 5% per year	Clark et al[74,119]
	Taiwan 7968 civil servants and teachers ≥ 50 years old (mean age: 57 years old) Follow-up: 15 yr	> 20% per year	Reviewed by KDIGO CKD Work Group[18]: Cheng et al[29]
	Taiwan 167 patients in a hospital based study	> 25% per year	Chen et al[85]
Review	Chronic kidney disease Lancet	> 4 mL/min per 1.73 m2 per year	Levey et al[3]
Guideline	KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease KDIGO CKD Work Group	> 5 mL/min per 1.73 m2 per year	Inker et al[10] KDIGO CKD Work Group[18]

CHS: Cardiovascular Health Study; KDIGO: Kidney Disease: Improving Global Outcomes; eGFR: Estimated glomerular filtration rate; CKD: Chronic kidney disease.