Original InvestigationPathogenesis and Treatment of Kidney DiseaseRelative Incidence of ESRD Versus Cardiovascular Mortality in Proteinuric Type 2 Diabetes and Nephropathy: Results From the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) Database
Section snippets
DIAMETRIC Database
We conducted a retrospective analysis of the DIAMETRIC database. The database was established in 2009 and is composed of patients with type 2 diabetes and nephropathy and significant proteinuria. The present analysis of the DIAMETRIC database consists of 3,228 patients randomly assigned in the IDNT (Irbesartan Diabetic Nephropathy Trial) and RENAAL (Reduction of Endpoints in Non–Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan) trial. The detailed design, rationale, and
Results
Table 2 lists baseline characteristics of the 3,228 evaluable patients. These patients had been followed up for a mean of 2.8 ± 1.0 years.
Table 3 lists crude event rates for primary and secondary end points. In all, 628 (19.5%) patients developed ESRD compared with the 260 (8.1%) cardiovascular deaths before ESRD, a nearly 2.5-fold difference. All-cause mortality prior to ESRD was 409 (12.7%) patients. An additional 328 patients had a doubling of baseline creatinine level that fell short of ESRD
Discussion
Patients with proteinuria and decreased kidney function due to type 2 diabetic nephropathy who were included in the DIAMETRIC database were 2.5 times more likely to develop ESRD than have a cardiovascular death. Only in the subgroup of patients with relatively well-preserved kidney function (eGFR >45 mL/min/1.73 m2) and initial ACR ≤1.0 g/g is this not the case, reflecting the low incidence of ESRD in this group within the follow-up period. Factors predicting the highest incidence rate ratio
Acknowledgements
We thank Ms Jill Keegan for assistance in preparing this manuscript.
Support: The RENAAL trial was sponsored by Merck & Company. Drs de Zeeuw and Cooper received financial support from Merck & Co for their participation in the steering committee of the RENAAL trial. Dr Shahinfar was an employee of Merck at the time of the conduct of the RENAAL trial. IDNT was sponsored by Bristol Myer Squibb Institute for Medical Research and Sanofi-Synthelabo. Dr Atkins received research grants from Bristol
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Originally published online November 4, 2011.