Clinical Significance of Decreased Glomerular Filtration Rate (GFR) without Albuminuria among Type 2 Diabetics

Ji Eun Lee; Kyu Chang Won; Hyoung Woo Lee; Ji Sung Yoon

doi:10.4093/kdj.2008.32.3.252

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Lee, Won, Lee, and Yoon: Clinical Significance of Decreased Glomerular Filtration Rate (GFR) without Albuminuria among Type 2 Diabetics

Original Article

Korean Diabetes Journal

Korean Diabetes Journal 2008; 32(3): 252-258.

Published online: 30 June 2008

DOI: https://doi.org/10.4093/kdj.2008.32.3.252

Clinical Significance of Decreased Glomerular Filtration Rate (GFR) without Albuminuria among Type 2 Diabetics

Ji Eun Lee, Kyu Chang Won, Hyoung Woo Lee, Ji Sung Yoon

Department of Internal Medicine, College of Medicine, Yeungnam University, Korea.

Received 10 October 2007 Accepted 22 May 2008

Abstract

Background

Microalbuminuria in type 2 diabetes is a predictor of development of clinical nephropathy and cardiovascular disease. But, it has been reported that reduced glomerular filtration rate (GFR) may occur in some normoalbuminuric diabetic patients. The aim of this study was to identify whether decreased GFR without microalbuminuria is to predict diabetic vascular complications.

Methods

Between January 1998 and February 2001, 73 patients with type 2 diabetes who visited Yeungnam university medical center were divided into 5 groups according to initial GFR ranges: group 1 (GFR < 30 mL/min), group 2 (30 ≤ GFR < 60 mL/min), group 3 (60 ≤ GFR < 90 mL/min), group 4 (90 ≤ GFR < 125 mL/min), group 5 (125 mL/min ≤ GFR). They were examined for microvascular and macrovascular complications initially and after 4 years.

Results

Decreased GFR had a negative correlation with age (γ = -0.472, P = 0.001). Decreased GFR without microalbuminuria had a significant correlation with development of diabetic nephropathy (P = 0.016) after 4 years. There were no significant correlation with the prevalence of diabetic retinopathy, peripheral neuropathy, and macrovacular disease. But, our study showed that coronary artery disease had an increasing tendency with decreased GFR without statistical significance (P = 0.085).

Conclusions

Our data suggest that reduced GFR, independent of albuminuria, may be an important predictor of diabetic nephropathy and coronary artery disease to some extent. So we recommend that not only the microalbuminuria, but also the decrease in GFR should be evaluated at the follow-up of patients with type 2 diabetes.

Keywords: Diabetic nephropathy, Glomerular filtration rate, Microalbuminuria

Figures and Tables

Fig. 1

A. The prevalence of diabetic nephropathy after 4 years by each group (P = 0.016). B. The prevalence of coronary heart disease after 4 years by each group (P = 0.085).

Table 1

Clinical characteristics of each groups

BP, blood pressure; BMI, body mass index; FBG, fasting blood glucose; C-pep, C-peptide; T-chol, total cholesterol; HDL, high density lipoprotein; LDL, low density lipoprotein; GGT, γ-glutamyl transferase; GFR, glomerular filtration rate. ^*P < 0.05.

Table 2

Follow-up diabetic complications of each groups

Table 3

Logistic regression analysis of diabetic nephropathy predictors

^*GFR, glomerular filtration rate.

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