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Diabetic kidney disease in the elderly: prevalence and clinical correlates
BACKGROUND: Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quali...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797340/ https://www.ncbi.nlm.nih.gov/pubmed/29394888 http://dx.doi.org/10.1186/s12877-018-0732-4 |
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author | Russo, Giuseppina T. De Cosmo, Salvatore Viazzi, Francesca Mirijello, Antonio Ceriello, Antonio Guida, Pietro Giorda, Carlo Cucinotta, Domenico Pontremoli, Roberto Fioretto, Paola |
author_facet | Russo, Giuseppina T. De Cosmo, Salvatore Viazzi, Francesca Mirijello, Antonio Ceriello, Antonio Guida, Pietro Giorda, Carlo Cucinotta, Domenico Pontremoli, Roberto Fioretto, Paola |
author_sort | Russo, Giuseppina T. |
collection | PubMed |
description | BACKGROUND: Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing. METHODS: Here we investigated the association of clinical variables and quality of care measures with eGFR+ and Alb+ in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, stratified by age. RESULTS: The prevalence of eGFR+ and Alb+ increased with ageing, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR+ and Alb + groups had the worst risk factors profile when compared to subjects without renal disease, showing a higher prevalence of out-of target values of HbA1c, BMI, triglycerides, HDL-C, blood pressure and more complex cardiovascular (CVD) and anti-diabetic therapies, including a larger use of insulin In all age groups, these associations differed according to the specific renal outcome examined: male sex and smoking were positively associated with Alb+ and negatively with eGFR+; age and anti-hypertensive therapies were more strongly associated with eGFR+, glucose control with Alb+, whereas BMI, and lipid-related variables with both abnormalities. All these associations were attenuated in the older (> 75 years) as compared to the younger groups (< 65 years; 65–75 years), and they were confirmed by multivariate analysis. Notably, Q-score values < 15, indicating a low quality of care, were strongly associated with Alb+ (OR 8.54; P < 0.001), but not with eGFR+. CONCLUSIONS: In T2DM patients, the prevalence of both eGFR and Albuminuria increase with age. DKD is associated with poor cardiovascular risk profile and a lower quality of care, although these associations are influenced by the type of renal abnormality and by ageing. These data indicate that clinical surveillance of DKD should not be unerestimated in old T2DM patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-018-0732-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5797340 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57973402018-02-12 Diabetic kidney disease in the elderly: prevalence and clinical correlates Russo, Giuseppina T. De Cosmo, Salvatore Viazzi, Francesca Mirijello, Antonio Ceriello, Antonio Guida, Pietro Giorda, Carlo Cucinotta, Domenico Pontremoli, Roberto Fioretto, Paola BMC Geriatr Research Article BACKGROUND: Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing. METHODS: Here we investigated the association of clinical variables and quality of care measures with eGFR+ and Alb+ in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, stratified by age. RESULTS: The prevalence of eGFR+ and Alb+ increased with ageing, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR+ and Alb + groups had the worst risk factors profile when compared to subjects without renal disease, showing a higher prevalence of out-of target values of HbA1c, BMI, triglycerides, HDL-C, blood pressure and more complex cardiovascular (CVD) and anti-diabetic therapies, including a larger use of insulin In all age groups, these associations differed according to the specific renal outcome examined: male sex and smoking were positively associated with Alb+ and negatively with eGFR+; age and anti-hypertensive therapies were more strongly associated with eGFR+, glucose control with Alb+, whereas BMI, and lipid-related variables with both abnormalities. All these associations were attenuated in the older (> 75 years) as compared to the younger groups (< 65 years; 65–75 years), and they were confirmed by multivariate analysis. Notably, Q-score values < 15, indicating a low quality of care, were strongly associated with Alb+ (OR 8.54; P < 0.001), but not with eGFR+. CONCLUSIONS: In T2DM patients, the prevalence of both eGFR and Albuminuria increase with age. DKD is associated with poor cardiovascular risk profile and a lower quality of care, although these associations are influenced by the type of renal abnormality and by ageing. These data indicate that clinical surveillance of DKD should not be unerestimated in old T2DM patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-018-0732-4) contains supplementary material, which is available to authorized users. BioMed Central 2018-02-02 /pmc/articles/PMC5797340/ /pubmed/29394888 http://dx.doi.org/10.1186/s12877-018-0732-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Russo, Giuseppina T. De Cosmo, Salvatore Viazzi, Francesca Mirijello, Antonio Ceriello, Antonio Guida, Pietro Giorda, Carlo Cucinotta, Domenico Pontremoli, Roberto Fioretto, Paola Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title | Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title_full | Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title_fullStr | Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title_full_unstemmed | Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title_short | Diabetic kidney disease in the elderly: prevalence and clinical correlates |
title_sort | diabetic kidney disease in the elderly: prevalence and clinical correlates |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797340/ https://www.ncbi.nlm.nih.gov/pubmed/29394888 http://dx.doi.org/10.1186/s12877-018-0732-4 |
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