Renal Function in Diabetes Patients Significantly Reduced by Certain Factors

Some conditions associated with type 2 diabetes may significantly impair renal function.

A new study found that 3 factors may impair normal renal function in patients with diabetes, and may impact how soon these patients require dialysis. These risk factors include acute kidney injury, proteinuria, and high or low blood glucose levels.

In the study, conducted at the University of Cincinnati College of Medicine, researchers examined 3679 patients with type 2 diabetes from the Cincinnati Veterans Affairs Medical Center who were followed-up with for 10 years. Patients were then placed into groups based on how many risk factors they had.

Renal function of patients without any risk factors were compared with patients who had 3 risk factors (severe risk group) and patients who had 1 or 2 risk factors (medium risk group).

"There are established risk factors in the diabetes literature," said corresponding author Charuhas Thakar, MD. "One of them is the level of sugar control; if you don't control your sugar well your kidney disease progresses faster or if you leak protein in the urine and you have proteinuria, it tends to be an independent predictor of kidney disease in diabetics."

According to the study, an average 50-year-old patient with type 2 diabetes and no risk factors has a kidney function of 60%, and will typically lose 1.9% to 2% of renal function per year. This particular patient would not require dialysis for 25 to 30 years, and would have normal renal function to age 80.

However, the researchers discovered that the same patient with all 3 risk factors will lose up to 5% of their renal function per year. This patient would require dialysis within 12 years at 62-years-old. The researchers reported that patients with 1 or 2 risk factors also experience a greater decline in renal function, although not as drastic as patients with all 3 factors.

"This is a big impact for a patient," Dr Thakar said. "You are talking about pruning 18 to 20 years off of when you will have to go on dialysis. It's very important information for a patient and clinician to know. The study is among the first to examine the interrelationship between these traditional risk factors for its effect on kidney disease progression."

These findings, which were presented at the American Society of Nephrology Kidney Week, could improve treatment for patients who are the most vulnerable to experiencing a kidney injury in the hospital.

Physicians should identify patients with type 2 diabetes who have these risk factors in order to create personalized monitoring and treatment approaches, according to the study.

"We have the same tools in our arsenal to help these patients in terms of their progression of kidney disease; so our research raises questions and challenges the field of physicians," Dr Thakar concluded. "We should find ways to monitor these three groups of patients differently and target our therapies. Future studies need to evaluate how we are going to change the trajectory of loss of renal function in these patients who may suffer a faster decline by either modifying existing treatment or discovering new therapies.”