Association of kidney disease measures with risk of renal function worsening in patients with hypertension and type 2 diabetes

J Diabetes Complications. 2017 Feb;31(2):419-426. doi: 10.1016/j.jdiacomp.2016.10.030. Epub 2016 Oct 29.


Aims: To assess the role of kidney disease measures on the development of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and hypertension (HT).

Methods: Clinical records from a total of 17,160 patients with T2D and HT, a baseline estimated glomerular filtration rate (eGFR) values ≥60mL/min/1.73m2, evaluation for albuminuria and regular visits during a four-year follow-up were retrieved and analyzed. The incidence of eGFR <60mL/min/1.73m2 and/or a reduction >30% from baseline was evaluated.

Results: At baseline 23% of patients (n=3873) had albuminuria. Over the 4-year follow-up 20% (n=3480) developed a renal endpoint 28% (n=1074) of those with albuminuria and 17% (n=2406) of those without albuminuria. The presence of baseline albuminuria entailed a 1.8 independent, greater risk of reaching stage 3 CKD. Patients with normal albuminuria showed a 1.54 (p<0.001) greater risk for each 5mL reduction (below 90mL/min) in baseline GFR.

Conclusions: In T2D patients with HT, eGFR reduction and albuminuria are independently associated with a greater risk of developing stage 3 CKD. While baseline albuminuria entails a greater renal risk, due to a larger occurrence of the non-albuminuric phenotype, renal function worsening is more likely to be observed in patients without albuminuria.

Keywords: Albuminuria; Chronic kidney disease; Glomerular filtration rate; Risk factors; Type 2 diabetes.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Albuminuria / etiology
  • Biomarkers / blood
  • Biomarkers / urine
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Angiopathies / complications*
  • Diabetic Nephropathies / complications*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / metabolism
  • Diabetic Nephropathies / physiopathology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Hypertension / complications*
  • Incidence
  • Italy / epidemiology
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Prevalence
  • Renal Insufficiency / complications*
  • Renal Insufficiency / epidemiology
  • Renal Insufficiency / metabolism
  • Renal Insufficiency / physiopathology
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / metabolism
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors


  • Biomarkers