• David K Packham, Tahira P Alves, Jamie P Dwyer, Robert Atkins, Dick de Zeeuw, Mark Cooper, Shahnaz Shahinfar, Julia B Lewis, and Lambers Heerspink Hiddo J HJ.
• Melbourne Renal Research Group, Royal Melbourne Hospital, Nephrology and Austin Hospital, Nephrology, Melbourne, Australia.
• Am. J. Kidney Dis. 2012 Jan 1; 59 (1): 75-83.

BackgroundPrevious studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial.Study DesignRetrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]).Setting & Participants3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria.InterventionAngiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials).Outcomes & MeasurementsIncidence rates of ESRD, cardiovascular death, and all-cause mortality.ResultsMean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline.LimitationsAll participants were included in a prospective clinical trial.ConclusionsPatients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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