Concomitant macro and microvascular complications in diabetic nephropathy

• Published in: Saudi journal of kidney diseases and transplantation Vol. 20; no. 3; pp. 402 - 409
• Main Authors: al-Suwayda, Abd al-Karim Umar, al-Wakil, Jamal S., Isnani, Arthur C., al-Harbi, Ali, Allam, Awatif A.
• Format: Journal Article
• Language: English
• Published: Riyadh, Saudi Arabia Saudi Center for Organ Transplantation 01-05-2009; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adult; Age of Onset; Aged; Aged, 80 and over; Blood Glucose - metabolism; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cholesterol - blood; Comorbidity; Complications; Complications and side effects; Creatinine - blood; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Angiopathies - etiology; Diabetic Angiopathies - mortality; Diabetic Angiopathies - physiopathology; Diabetic nephropathies; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - etiology; Diabetic Nephropathies - physiopathology; Diabetic neuropathies; Disease Progression; Female; Glomerular Filtration Rate; Humans; Hypertension - etiology; Hypertension - physiopathology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - physiopathology; Male; Microcirculation; Middle Aged; Nephropathy; Odds Ratio; Prevalence; Retrospective Studies; Risk Assessment; Saudi Arabia - epidemiology; Sex Factors; Time Factors; اعتلال الكلى السكري; الأمراض; الجهاز القلبي الوعائي; المرضى; المضاعفات; Saudi Arabia
• ISSN: 1319-2442; 2320-3838

To determine the prevalence of concomitant microvascular and macrovascular complica­tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia­betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Dete­rioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing com­plications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggre­ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD.