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概要

Onset of End-Stage Renal Disease and Prevalence of Vascular Diseases at the Start of Dialysis in Type 2 Diabetic Patients with Diabetic and Vascular Nephropathy

Biesenbach G and Pieringer H

Background: End-Stage Renal Disease (ESRD) in type 2 diabetic patients with renal disease can be observed after a varying duration of diabetes. The aim of the study was to investigate differences between type 2 diabetic patients with diabetic nephropathy (dNP) versus Vascular Nephropathy (vNP).

Patients and Methods: We investigated 90 uremic type 2 diabetic patients before start of dialysis. According to clinical diagnosis 66 patients had dNP (72%) and 20 patients vNP (24%) and four patients a chronic glomerulo nephritis was diagnosed (4%). The clinical diagnose was confirmed by histological findings in 40 patients, of them in 28 patients with dNP and in 12 subjects a histological finding was available. In 14 cases a kidney biopsy performed and in 26 patients a post-mortem biopsy at autopsy. Differences in the onset of ESRD in the presence of dNP and vNP were evaluated. Additionally, at the start of dialysis we investigated the prevalence of vascular diseases in relation to renal disease and diabetes duration.

Results: The patients were divided into 3 groups, depending on the duration of diabetes. In group 1 diabetes duration was <15 years (n=30), In group 2 duration was 15-20 years (n=44), and in group 3 >20 years (n=16). The majority of the patients with dNP had diabetes for 15-20 years (50%) while most of those with vNP usually had diabetes for <15 years (55%). The prevalence of vascular diseases was similar in both groups. The prevalence of coronary artery disease was slightly higher in patients with dNP but not significant.

Conclusion: In patients with dNP the duration of diabetes until onset of ESRD was longer than in patients with vNP, however, marked variationts were found. At onset of ESRD the prevalence of vascular diseases was similarin patients with dNP and vNP, though in thevNP group the diabetes duration was significantly longer. This can be explained by a higher age of the patients with vNP Diabetes – end-stage renal disease – diabetic nephropathyvascular nephropathy – vascular diseases.