Prevalence Of Impaired Gfr During Microalbuminuria In Type And Type Diabetes

Assessments of GFR in patients with microalbuminuria can be performed either cross-sectionally or longitudinally. The former yields data on prevalence and is heavily influenced by age, whereas the latter yields data on rate of GFR decline which is strongly influenced by blood pressure especially in type 2 diabetes. It follows that cross-sectional studies would be expected to show a higher prevalence of impaired GFR in elderly subjects with type 2 diabetes than in younger patients with type 1 diabetes. Also, longitudinal studies in elderly subjects with type 2 diabetes would be expected to show the age-related rate of decline of GFR of 1ml/min/year which has been documented in cross-sectional population studies [74, 75], in addition to any decline in GFR associated with diabetic nephropathy.

The first population-based study on the prevalence of impaired renal function in the United States was performed in NHANES III [8] (Table 1). Impairment of GFR in the range 15-60 ml/min/1.73m2 was observed in 3.9% of non-diabetic and 15.1% of diabetic participants. The prevalence of impaired GFR < 60 ml/min/1.73m2 in diabetic participants was too low to calculate in the 2040 year age group, but increased from approximately 3% in the 40-59 year age group to approximately 35% in the > 70 year age group [8]. NHANES III also showed that impaired GFR is observed with a greater prevalence in older, hypertensive subjects without diabetes [76].

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