Researchers have investigated the association of clinical variables and quality of care measures with estimated glomerular filtration rate (eGFR +) and albuminuria (Alb +) in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists ( AMD ) Annals Initiative, stratified by age.
Diabetic kidney disease (DKD) is a major burden in patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR +, <60 mL / min / 1.73 m2) and Alb + are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by aging .
Kidney dysfunction is rising worldwide in parallel with population aging, being diagnosed in about 25% of people aged 65-74 years, and in> 50% of those aged> 75 years.
Senescence is associated to a progressive decline ofeGFR of about 1-2 ml / min per year, depending on ethnic, genetic and environmental factors, which may limit renal reserve and make this organ susceptible to damage by several factors, including type 2 diabetes mellitus ( T2DM ).
The prevalence of eGFR + and Alb + increased with aging, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR + and Alb + groups had the worst risk factors when compared to subjects without renal disease.
They are 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 +, BMI, and lipid-related variables with both abnormalities.
All these associations were attenuated in the older (> 75 years), and 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 +.
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