Risk Factors for Development and Progression of Diabetic Kidney Disease and Treatment Patterns Among Diabetic Siblings of Patients With Diabetic Kidney Disease

Bleyer, Anthony J.; Sedor, John R.; Freedman, Barry I.; O’Brien, Alicia; Russell, Gregory B.; Graley, Joni; Schelling, Jeffrey R.

doi:10.1053/j.ajkd.2007.10.029

« Previous Next »American Journal of Kidney Diseases
Volume 51, Issue 1 , Pages 29-37, January 2008

Risk Factors for Development and Progression of Diabetic Kidney Disease and Treatment Patterns Among Diabetic Siblings of Patients With Diabetic Kidney Disease

Anthony J. Bleyer, MD, MS
- Section on Nephrology, Wake Forest University School of Medicine, Winston Salem, NC
- Address correspondence to Anthony J. Bleyer, MD, MS, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27106.
John R. Sedor, MD
- Department of Medicine, Rammelkamp Center for Research and Education, Case Western Reserve University School of Medicine, Cleveland, OH
Barry I. Freedman, MD
- Section on Nephrology, Wake Forest University School of Medicine, Winston Salem, NC
Alicia O’Brien, RN
- Department of Medicine, Rammelkamp Center for Research and Education, Case Western Reserve University School of Medicine, Cleveland, OH
Gregory B. Russell, MS
- Section on Biostatistics, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC.
Joni Graley, RN
- Section on Nephrology, Wake Forest University School of Medicine, Winston Salem, NC
Jeffrey R. Schelling, MD
- Department of Medicine, Rammelkamp Center for Research and Education, Case Western Reserve University School of Medicine, Cleveland, OH

Received 9 May 2007; accepted 5 October 2007.

Background

Diabetic siblings of patients with treated kidney failure from diabetic kidney disease are at a 5-fold increased risk of future kidney failure. The objective of this study is to define risk factors for kidney disease, clinical features, and treatment patterns in diabetic siblings of patients with diabetes with diabetic kidney disease.

Study Design

Cross-sectional analysis using data collected from diabetic siblings of patients with diabetic kidney disease.

Setting & Participants

295 diabetic siblings with mean diabetes duration of 15 years from within a 400-mile radius of Cleveland, OH, or Winston-Salem, NC.

Predictors

Demographic data, diabetes duration, blood pressure (BP), access to health care, and diabetes control.

Outcomes

Albuminuria (defined as urinary albumin-creatinine ratio ≥ 30 mg/g, with microalbuminuria with albumin of 30 to 300 mg/g and macroalbuminuria with albumin > 300 mg/g), renal function.

Measurements

BP, urinary albumin-creatinine ratio, serum creatinine, glycosylated hemoglobin (HbA_1c), estimated glomerular filtration rate.

Results

Mean diabetes duration was 14.6 ± 10.6 years. Albuminuria was present in 46% of participants. In individuals with diabetes duration of 11 to 15 years, 25% had microalbuminuria and 18.2% had macroalbuminuria. Despite a positive family history and a high prevalence of albuminuria, only 35.3% of participants had a target systolic BP less than 130 mm Hg. HbA_1c levels were 7% or greater in 57.4% of patients, and 26.4% of participants were smokers. Only 58% of patients received angiotensin-converting enzyme inhibitors or receptor blockers. In microalbuminuric participants, HbA_1c level was greater than 10% in 28.6% versus 13.3% in those without albuminuria (P = 0.02).

Limitations

A control group of diabetic siblings without a family history of diabetic kidney disease was not obtained.

Conclusions

Diabetic siblings of patients with diabetic kidney disease have a high prevalence of albuminuria and poor glycemic and BP control. Targeting these high-risk individuals for interventions to improve their BP and blood glucose control might prevent or slow the progression of diabetic kidney disease.

Index Words: Diabetes, diabetic nephropathy, epidemiology, genetics, prevention